Search

Acute ischemic stroke (AIS) occupies one of the leading places in the structure of disability and mortality in adult population throughout the world, which causes a significant social and economic burden of this pathology. Recent advances in AIS diagnosis and treatment have significantly reduced mortality and improved functional outcomes in patients. However, categories of patients with unsatisfactory results and complications of reperfusion therapy still remain. In some of them, mortality may exceed the overall rate. To this day, there are controversial aspects in determining indications and choosing the preferred method of cerebral reperfusion. The presented cases describe the results of using thrombolytic therapy and thromboextraction in AIS patients of different age groups. The importance of various neuroimaging methods (multislice computed tomography, computed angiography, duplex ultrasound of extra- and intracranial arteries) for timely diagnosis and determination of optimal revascularization tactics was noted.

Pericardial cysts are rare benign tumors often discovered incidentally during radiological examinations. Despite being predominantly asymptomatic, they can cause significant clinical manifestations and complications. The article describes a case of migrating pericardial cyst that was initially misinterpreted as left-sided encysted pleural effusion. Detailed assessment of dynamic changes on multislice computed tomography and subsequent surgical treatment revealed that the neoplasm originated from the pericardial layers altering its location, shape, and size. Awareness of the phenomenon of pericardial cyst migration and the use of up-to-date imaging techniques play a crucial role in accurate diagnosis and selecting optimal treatment strategies.

Cor triatriatum dexter is a rare congenital heart anomaly in which the right atrium is divided into 2 chambers by a membrane. Clinical manifestations vary depending on the degree of the right atrium separation and the presence of concomitant anomalies. We report a case of asymptomatic cor triatriatum dexter diagnosed during transthoracic echocardiography. The diagnosis was confirmed by transesophageal echocardiography, computed tomography, and magnetic resonance imaging. Transthoracic echocardiography is a sensitive primary diagnostic tool for such congenital heart disease as cor triatriatum dexter.

Pulmonary arterial hypertension affects females more frequently than males, and there are known sex‐related differences in the lungs. However, normal sex‐related differences in pulmonary vascular structure remain incompletely described. We aimed to contrast computed tomography‐derived pulmonary vascular volume and its distribution within the lungs of healthy adult females and males. From the CanCOLD Study, we retrospectively identified healthy never‐smokers. We analyzed full‐inspiration computed tomography images, using vessel and airway segmentation to generate pulmonary vessel volume, vessel counts, and airway counts. Vessels were classified by cross‐sectional area >10, 5–10, and <5 mm2 into bins, with volume summed within each area bin and in total. We included 46 females and 36 males (62 ± 9 years old). Females had lower total lung volume, total airway counts, total vessel counts, and total vessel volume (117 ± 31 vs. 164 ± 28 mL) versus males (all p < 0.001). Females also had lower vessel volume >10 mm2 (14 ± 8 vs. 27 ± 9 mL), vessel volume 5–10 mm2 (35 ± 11 vs. 55 ± 10 mL), and vessel volume <5 mm2 (68 ± 18 vs. 82 ± 19 mL) (all p < 0.001). Normalized to total vessel volume, vessel volume >10 mm2 (11 ± 4 vs. 16 ± 4%, p < 0.001) and 5–10 mm2 (30 ± 6 vs. 34 ± 5%, p = 0.001) remained lower in females but vessel volume <5 mm2 relative to total volume was 18% higher (59 ± 8 vs. 50 ± 7%, p < 0.001). Among healthy older adults, pulmonary vessel volume is distributed into smaller vessels in females versus males. [ABSTRACT FROM AUTHOR]

The aim was to evaluate the potential of various imaging methods in the diagnosis of vulnerable coronary plaques and their stabilization using various lipid-lowering therapy regimens.The sources were searched in the PubMed database using the following keywords: "vulnerable (unstable) plaque" AND "PCSK9 inhibitors" AND "intravascular ultrasound" OR "optical coherence tomography" OR "computed tomography angiography". As a result, 8 original clinical trials were selected that corresponded to the review purpose. We assessed the results of following studies on plaque imaging and their regression with various lipid-lowering therapy regimens: GLAGVO, ODYSSEY J, PACMAN-AMI, HUYGENS, ALTAIR, ARCHITECT, etc. The results of most studies have established the advantages of a combined regimen of lipid-lowering therapy (statin+PCSK9 inhibitor) in reducing the rate of cardiovascular events in com­parison with statin monotherapy. The reduction in plaque volume ranged from 0,95% to 2,13% in patients receiving a combination of lipid-lowering drugs, while in monotherapy, it increased from 0,05% to 0,92% (GLAGOV, PACMAN-AMI). The changes of minimum fibrous cap thickness varied from 18,0-62,67 µm with combined therapy and 13,2-33,19 µm with monotherapy (PACMAN-AMI, Gao F). Lipid arc regression was 57,5о in combination therapy (statin+PCSK9 inhibitor) and 31,4о in statin monotherapy (HUYGENS). Imaging diagnostic methods makes it possible to identify vulnerable plaques, which helps in consideration of combination lipid-lowering therapy. In addition, plaque visualization makes it possible to evaluate the treatment effectiveness.

Background. The purpose is to determine the place and role of oblique projections in the analysis of multislice computed tomography (MSCT) data in gunshot wounds. Materials and me­thods. More than 3,300 MSCT studies performed in wounded and traumatized patients over a certain period in the Military Medical Clinical Center of the Northern Region of the Medical Forces Command were prospectively studied. All the wounded were male, the average age was 42.1 ± 2.4 years. MSCT of the head, thoracic and abdominal organs, pelvis, and limbs was performed. The frequency of using oblique projections and their informativeness were studied. Results. A prospective study demonstrated that coronal, axial, sagittal projections, and 3D modeling were used in 100 % of cases, and in 21.4 % — oblique projections to improve MSCT results. The distribution by localization of MSCT was as follows: head — 32.9 %, neck — 7.6 %, chest organs — 32.2 %, abdominal organs — 22.3 %, limbs — 5.0 %. MSCT in angiomode was performed in 3.5 % of injured and traumatized patients: head — 27.2 %, neck — 18.4 %, chest organs — 28.9 %, abdominal organs — 23.7 %, limbs — 1.8 %. Oblique projections in MSCT data analysis were used when studying the wound channel in 82.3 % of cases, to improve the visualization of vessels during MSCT in angiomode — in 12.6 % and to improve the visualization of bone fracture lines — in 5.1 %. Conclusions. In the structure of MSCT studies, the head, thoracic organs, abdominal organs, neck, and limbs prevail by localization (in descending order). Oblique projections are used is 1/5 of cases and allow to improve the visualization of the direction of the wound channel, vessels during angiography and lines of flat and long tubular bone fractures.

Background Semi-automated software is essential for planning and prosthesis selection prior transcatheter aortic valve replacement (TAVR). Reliable data on the usability of software programs for planning a TAVR is missing. The aim of this study was to compare software programs ‘Valve Assist 2’ (GE Healthcare) and 3mensio ‘Structural Heart’ (Pie Medical Imaging) regarding usability and accuracy of prosthesis size selection in program-inexperienced users. Methods Thirty-one participants (n=31) were recruited and divided into program-inexperienced users (beginners) (n=22) and experts (n=9). After software training, beginners evaluated 3 patient cases in 129 measurements (n=129) using either Valve Assist 2 (n=11) or Structural Heart (n=11) on 2 test days (T1, T2). System Usability Scale (SUS) and ISONORM 9241/110-S (ISONORM) questionnaire were used after the test. The valve size selected by each begin‑ ner was compared with the valve size selected from expert group. Results Valve Assist 2 had higher SUS Score: median 78.75 (25th, 75th percentile: 67.50, 85.00) compared to Structural Heart: median 65.00 (25th, 75th percentile: 47.50, 73.75), (p<0,001, r=0.557). Also, Valve Assist 2 showed a higher ISONORM score: median 1.05 (25th, 75th percentile:−0.19, 1.71) compared to Structural Heart with a median 0.05 (25th, 75th percentile:−0.49, 0.13), (p=0.036, r=0.454). Correctly selected valve sizes were stable over time using Valve Assist 2: 72.73% to 69.70% compared to Structural Heart program: 93.94% to 40% (χ2 (1)=21.10, p<0.001, φ=0.579). Conclusion The study shows signifcant better usability scores for Valve Assist 2 compared to 3mensio Structural Heart in program-inexperienced users. [ABSTRACT FROM AUTHOR]

Background: Current guidelines consider atrial fibrillation (AF) type as the prognostic factor for a recommendation of catheter ablation. We aimed to determine whether LA and LA appendage (LAA) volumes measured using multislice computed tomography (MSCT) were related to long-term outcomes in AF following radiofrequency catheter ablation (RFCA). Methods: We evaluated 152 consecutive patients with drug-refractory AF (median age, 55.8 ± 9.6 years), including 110 male patients, who underwent RFCA in a single center. All patients underwent MSCT imaging for anatomical assessment. The endpoint of this study was documented AF recurrence after RFCA. Results: The overall procedure success rate was 77.6% (n = 118) during a mean follow-up period of 12.6 months. The LA volume was significantly larger for those who experienced AF recurrence after RFCA than for the patients without recurrent AF after the procedure (153.8 ± 29.9 mL vs. 139.2 ± 34.1 mL, p = 0.025). However, LAA volumes were nearly equivalent between the patients with and without AF recurrence after RFCA (16.2 ± 6.3 mL and 14.7 ± 6.5 mL, respectively; p = 0.235). LA volume ≥ 153.2 mL was the optimal cutoff value for estimating AF recurrence after RFCA, with 94% sensitivity and 66% specificity. LA volume remained an independent predictor of both AF recurrence and permanent AF. Conclusions: LA volume as assessed by MSCT might be helpful for identifying patients likely to achieve successful AF ablation. LA volume ≥ 153.2 mL, but not LAA volume, showed good accuracy in predicting AF recurrence after RFCA. [ABSTRACT FROM AUTHOR]

Objective: To summarize the scientific evidence on the prevalence of maxillary sinus hypoplasia (MSH) and associated anatomical variations as assessed by computed tomography scans. Study design: This PROSPERO-registered systematic review followed the recommendations of the PRISMA guidelines. Search algorithms were constructed for each of the six databases and gray literature. After screening the references (Rayyan®), the extracted data were meta-analyzed according to a random-effects model. The joanna briggs critical appraisal tool assessed the methodological quality of the included studies. The GRADE approach was used to estimate the certainty of the evidence. Results: From a total of 2781 studies screened, 22 were considered for four meta-analysis. The prevalence of MSH in 7358 patients was 5.65% (CI95% = 4.07–7.47%) with significant heterogeneity between studies (p < 0.001, I2 = 89.30%). MSH was identified in 295 patients, of whom 82.38% (CI95% = 75.82–88.09%) had unilateral hypoplasia and 17.62% (CI95% = 11.91–24.18%) bilateral hypoplasia with moderate heterogeneity between studies (p < 0.0503, I2 = 42.87%). The prevalence of MSH in 9998 maxillary sinuses was 3.77% (95% CI = 2.44–5.38%), with significant heterogeneity between studies (p < 0.001, I2 = 92.84%). Hypoplastic/aplastic uncinate process, concha bullosa and paradoxical concha were the most reported anatomical variations. The studies presented a low-moderate methodological quality. The certainty of the evidence was very low to moderate. Conclusion: The prevalence of maxillary sinus hypoplasia observed was 5.65%, with most cases being unilateral. [ABSTRACT FROM AUTHOR]

Inflammatory conditions such as chronic otitis media (COM) can cause irreversible impairments in the microarchitecture and functions of the incus, which subsequently leads to conductive hearing loss. To investigate bone mineral density (BMD) of the incus body (IB) and long process (ILP) on preoperative temporal CT in COM patients with and without incudo-stapedial joint discontinuity (ISJD), and also to determine the association between BMD values and the postoperative air-bone gap (ABG) in the ISJD group. The mean IB density (IBD)/occipital bone density (OBD) and ILP density (ILPD)/OBD values were compared between the patients with and without ISJD. The correlation between ABG gain and preoperative incus density values was assessed in the ISJD group. The mean IBD/OBD and ILPD/OBD values were significantly higher in patients with intact ISJ. There was a moderate positive correlation between postoperative ABG gain and ILPD/OBD values in the ISJD group. The decrease in BMD of the incus may involve ILP as well as IB in patients with ISJD caused by ILP lysis in COM. A higher preoperative ILPD/OBD was correlated with a higher postoperative ABG gain in COM patients with ISJD. [ABSTRACT FROM AUTHOR]

Abstract Pulmonary arterial hypertension affects females more frequently than males, and there are known sex‐related differences in the lungs. However, normal sex‐related differences in pulmonary vascular structure remain incompletely described. We aimed to contrast computed tomography‐derived pulmonary vascular volume and its distribution within the lungs of healthy adult females and males. From the CanCOLD Study, we retrospectively identified healthy never‐smokers. We analyzed full‐inspiration computed tomography images, using vessel and airway segmentation to generate pulmonary vessel volume, vessel counts, and airway counts. Vessels were classified by cross‐sectional area >10, 5–10, and 10 mm2 (14 ± 8 vs. 27 ± 9 mL), vessel volume 5–10 mm2 (35 ± 11 vs. 55 ± 10 mL), and vessel volume 10 mm2 (11 ± 4 vs. 16 ± 4%, p

Background. Pancreatic head cancer ranks 6–7th among oncologic diseases and 4–5th among causes of mortality, with only 5% of patients achieving 5-year survival rate to date. Despite the successes of modern diagnostics and surgical treatment, the problem of early detection, staging of oncologic process and, as a consequence, combined treatment of pancreatic head cancer remains actual.Objective: increasing the accuracy of diagnostics and estimation of resectability of the pancreatic head cancer on the basis of the complex use of the radiation methods of investigation with pancreaticoduodenal zone 3D-reconstructions.Material and methods. The study included 93 patients (44 (47.31%) males and 49 (52.69%) females) with complicated pancreatoduodenal masses treated from 2019 to 2022 at the Surgical Department of the City Mariinsky Hospital. The patients’ age varied from 44 to 90 years, the mean age was 67±0.74 years. All patients underwent magnetic resonance imaging (MRI) on an Ingenia MR tomograph (Philips Medical Systems, Netherlands) with a magnetic field induction of 3 Tesla. The native examination of the abdomen and retroperitoneum, supplemented with MR-cholangiopancreatography protocol, and dynamic contrast enhancement with data collection in arterial, portal, and delayed phases were carried out. T2-weighted images were then performed using turbospin-echo technology, including fat-suppressed images, to evaluate structural changes and the presence of fluid in fascial spaces. Patients also underwent endoscopic ultrasound of the pancreaticoduodenal zone using the push and pull method, and abdominal multislice computed tomography (MSCT). To build 3D models, we used free 3D-slicer and Mimics programs, which allowed to build semi-automatic model for further evaluation of anatomo-topographic relations.Results. MSCT 3D modeling revealed tumor invasion into the superior mesenteric vein in 6 (23.06%) patients, whereas MRI models showed tumor invasion in 4 (15.38%) patients, intraoperatively the results were confirmed in 5 patients (19.23%). According to both MSCT and MRI modeling data, the invasion of the ventral trunk occurred in 1 (5.2%) case, which was confirmed intraoperatively. Inferior vena cava invasion on MSCT and MRI models was detected in 3 (11.54%) patients, whereas intraoperatively – in 4 (15.38%) patients. The MSCT and MRI 3D models coincided with the data on invasion of the ventral trunk in 1 (3.85%) patient and the superior mesenteric artery in 2 (7.69%) patients, which was fully confirmed intraoperatively.Conclusion. 3D modeling on the basis of MRI and MSCT studies is an informative method in preoperative staging of pancreatic head cancer and its resectability. This method allows to objectively determine the localization and prevalence of the tumor process on adjacent anatomical structures, as well as visually demonstrate the metastatic lesion of regional lymph nodes. By the parameters of diagnostic efficiency, 3D models are maximally close to the intraoperative picture, which allows planning both the volume and the course of surgical intervention.

The pneumatization of the articular portion of the temporal bone is an anatomical variant that can modify the barrier between the articular space and the middle cranial fossa. Thus, this study aimed to identify the presence and degree of pneumatization, as well as the existence of pneumatic cell dehiscence towards the extradural or articular space determining whether it could lead to direct communication between the articular and extradural spaces. Hence, One-hundred skull computed tomography images were selected. The presence and extension of pneumatization were classified according to scores 0, 1, 2, and 3. Dehiscence towards extradural and articular spaces was recorded. In total, 200 TMJ from 100 patients were assessed and 40.5% of pneumatization cases were observed. The most prevalent score was 0 (restricted to the mastoid process), while the least prevalent score was 3 (extending beyond the crest of articular eminence). Dehiscence of the pneumatic cells towards the extradural space is more common than towards the articular space. One complete communication between the extradural and articular spaces was observed. Considering the results, it was concluded that to avoid neurological and ontological complications, awareness of the potential anatomical communications between articular and extradural spaces, particularly in patients with extensive pneumatisation, is necessary. [ABSTRACT FROM AUTHOR]

Objective: to compare intra- and inter-operator reproducibility of thoracic aorta (ThAo) morphometric parameters, calculated by multislice computed tomography (MSCT) and magnetic resonance imaging (MRI).Material and methods. The prospective study included 20 patients with ascending aorta (AAo) dilatation (≥45 mm). All patients underwent MSCT- and MRI-angiography in electrocardiogram-gated mode. Mean diameter (Dmean) and cross-sectional area (CSA) were measured at different ThAo levels in the systole and diastole along the inner contour of the vessel. All measurements were performed by two radiologists. Each of them took measurements twice at an interval of at least 1 month. The reproducibility of repeated measurements was studied using intraclass correlation coefficient. Results. The analysis of the systolic frame revealed significant differences between the methodsfor measuring Dmean (MRI: 42.5 (41.0–47.8) mm; MSCT: 37.7 (34.7–40.3) mm; p = 0.003) and CSA at the level of the sinotubular junction (MRI: 14.8 (12.7–17.9) cm2; MSCT: 11.4 (10.3–13.3) cm2; p = 0.009), AAo CSA(MRI: 17.6 (14.6–20.8) cm2; MSCT: 19.6 (16.7–21.5) cm2; p = 0.035) and Dmean at the level proximal to left subclavian artery (LSA) (MRI: 31.5 (31.0–34.0) mm; MSCT: 31.7 (27.3–32.9) mm; p = 0.041). For the diastolic frame, significant differences between the methods were observed when measuring AAo CSA (MRI: 17.0 (14.5–19.7) cm2; MSCT: 19.7 (15.3–21.8) cm2; p = 0.025), Dmean (MRI: 30.5 (29.3–32.8) mm; MSCT: 29.8 (27.1–31.3) mm; p = 0.05) and CSA at the level proximal to LSA (MRI: 7.5 (6.9–7.9) cm2; MSCT: 7.4 (5.9–7.8) cm2; p = 0.007), as well as CSA at the left atrium level (MRI: 4.9 (4.2–5.0) cm2; MSCT: 5.1 (4.67–5.5) cm2; p = 0.042). For MSCT-angiography, good intra- and inter-operator reproducibility of measurements at all ThAo levels was obtained. For MRI-angiography, there was a strong intra- and interoperator variability in determining Dmean and CSA at the levels of aortic arch and descending aorta.Conclusion. Aortic cross-sectional area showed the best intra- and inter-operator reproducibility and comparability of measurements between MSCT- and MRI-angiography

Background: Talus fractures are one of the most dangerous injuries leading to serious consequences. Quite a lot of treatment methods have been proposed, but the use of the Ilizarov apparatus is relatively rare. Objective: To justify the use of the Ilizarov apparatus in the talus fracture treatment by studying radiomorphological parameters of the foot bones at different stages of follow-up. Methods: We used radiography and multislice computed tomography (MSCT) in 25 patients treated for talus injuries by the Ilizarov apparatus to study radiographic and radiomorphological features of the foot bones at different stages of follow-up. We analyzed normal parameters of the foot bones forming the ankle joint in 15 patients. Results and discussion: Dynamics of talus radiomorphology during its fracture or fracture-dislocation are characterized by a gradual increase in the bone density at the union site. The local density of the talus at the fracture site gradually increased and exceeded 500 HU in 6 months. The organotypic adjustment at the union site did not end by this time, given the architecture of the talus and the biomechanics of the foot. We observed a decrease in the total densities of the talus and calcaneus during fixation by the Ilizarov apparatus and their gradual return to normal values after removal of the apparatus. Conclusions: Talus fracture treatment by transosseous osteosynthesis using the Ilizarov apparatus makes it possible to get immediate good results, especially using a configuration with hinges allowing for early mobilization of the ankle joint and loading in the early stages of treatment.

Copyright of Turkiye Klinikleri Archives of Lung is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To study the correlation between epicardial fat thickness (EFT), pericoronary fat thickness (PCFT), and pericoronary fat density (PCFD) with the existence and severity of coronary artery disease (CAD). Methods: This cross-sectional study included 210 patients referred for multislice CT angiography. Group I normal CTCA, Group II patients had non-obstructive atherosclerosis, and Group III patients had obstructive atherosclerosis. All patients underwent a clinical examination, history taking, and multislice CT angiography. Results: The mean EFT was significantly greater in group III (10.43 ± 2.31 mm) compared to groups II (6.30 ± 1.61 mm) and I (5.06 ± 1.14 mm). The mean PCFT was significantly greater in group III (17.96 ± 2.89 mm) compared to group II (11.47 ± 2.51 mm) and group I (9.67 ± 1.99 mm). PCFD was significantly higher adjacent to the lesion (−80.47 ± 29.14) compared to the normal segment (−109.03 ± 35.24), higher in the obstructive group (−59.44 ± 20.10) compared to the non-obstructive group (−101.51 ± 20.23), but lower in calcified lesions (−89.58 ± 28.94) compared to non-calcified (−75.01 ± 29.20), and mixed lesions (−74.83 ± 26.90). EFT and PCFT cut-off values for predicting obstructive CAD were 8.3 and 12.4 mm, respectively, with 87.1% and 92.9% sensitivity and 92.9% and 86.4% specificity, respectively. Conclusion: There is a significant association between epicardial fat thickness, pericoronary fat thickness and density with the severity of coronary artery disease.

Objective: The orbit is an important cavity containing vision-related formations and important neurovascular structures, and adjacent to various regions. This study aimed to evaluation, by multidedector computed tomography (MDCT) images, the morphometry of orbit by examining its changes according to gender and body side, and developments according to age, in Turkish population. Materials and Methods: A total of 200 individuals’s (94 females,106 males;400 sides) MDCT images were evaluated. Images were examined according to the gender, body side, and the anatomical structures development. Results: The height, width and depth of the orbit were determined as 36.04±2.97 mm, 32.33±2.59 mm, 38.35±3.32 mm on the right side, 35.79±3.18 mm, 32.29±2.67 mm, 38.13±3.21 mm on the left side, respectively, in healthy subjects. The height and width of the orbit were found to be statistically significantly larger on both sides in men than in women (p˂0.05). Conclusion: Comprehensive information about the orbit and associated apertures is quite important for clinicians working in this area, damage to these structures can cause serious complications. In addition, determining the morphometry of the orbit can be used as an important parameter for determining gender, age and race in forensic medicine.

Introduction: Computed tomography angiography (CTA) and ventilation/perfusion (V/Q) single photon emission computed tomography/CT (SPECT/CT) images have been widely used to detect PE, but few studies have performed a direct comparison between them. We aimed to evaluate the performance of these tests in the same group of patients, selected from the routine practice of a general hospital. Methods: Patients with suspected acute PE were prospectively submitted to CTA and V/Q SPECT/CT. General radiologists and nuclear physicians, respectively, interpreted the images. Data regarding age, sex, time between examinations, symptoms, and Wells score were also recorded. The final diagnosis was decided through a consensus among the clinicians, taking into account clinical, laboratory, follow-up, and all imaging procedures data. Results: Twenty-eight patients (15 male, 13 female, and median age of 51.5 years) were studied. Median duration of the onset of symptoms was 4 (1–14) days, and the median Wells score was 3.5 (1.5–6). Sensitivity, specificity, positive and negative predictive values, and accuracy were 84.6%, 80.0%, 78.6%, 85.7%, and 82.1% for V/Q SPECT/CT, and 46.1%, 100%, 100%, 68.2%, and 75.0% for CTA. The overall agreement between the methods was 57.1%. Of the 22 patients with negative CTA, 10 (45.4%) had positives V/Q SPECT/CT and seven of them classified as true positives. Conclusions: Our results suggest that V/Q SPECT/CT is more sensitive and accurate than CTA when interpreted by general radiologists and nuclear medicine physicians. [ABSTRACT FROM AUTHOR]

A rare case of jejunal lipoma complicated by intestinal intussusception in a 71-year-old man is presented. Abdominal computed tomography revealed intestinal intussusception caused by the jejunal wall lipoma, allowed to timely make a diagnosis and perform surgical treatment.

The jejunal diverticulosis is rare and accounts for approximately 0.5–1 % of the general population. Diagnosis of the pathology is difficult even in the presence of symptomatic complications (perforation, abscess, peritonitis, sepsis, intestinal obstruction and bleeding), therefore, it is often overlooked or delayed, which requires high awareness and vigilance of physicians. Emergency surgical interventions are performed due to the lack of clear clinical symptoms and reliable radiological data in an average of 25 % of patients with complications of diverticulosis. In the presented case, multislice computed tomography (MSCT) with intravenous contrasting revealed multiple diverticula of the jejunum with reactively altered walls, infiltration of the adjacent cellular tissue and small gas inclusions, indicating diverticulum microperforation. Esophagogastroduodenoscopy (EGD) was performed which confirmed the jejunum bleeding, and was followed by laparotomy which confirmed multiple jejunal diverticula with microperforation and bleeding. Thus, timely MSCT in combination with EGD allowed to avoid complications of jejunal diverticulitis.

Background: The aim of our study is to determine the radiation dose to which the breast is exposed in pediatric female undergoing routine thoracic multislice computed tomography (MSCT) and to investigate the effectiveness of bismuth shielding in reducing this dose. Materials and Methods: Twenty patients who were referred to the radiology department for routine thorax MSCT between January 2012 and April 2012 were included in the study. A Thermolucent dosimeter (TLD) (3x3x1mm; Harshaw Lif TLD-100; Saint-Gobain Industrial Ceramics, Solon, Ohio) was placed on both breast skins of the patients to measure the radiation dose. An in-plane bismuth breast shield was placed on the right breast, and the left breast was chosen as the unshielded side. Radiation doses in the shielded and unshielded breast were calculated and compared using the Paired-t test. Results: The mean radiation doses were calculated as 7.0075 mSv and 9.0730 mSv for the shielded right breast and the unshielded left breast, respectively. It was found that in-plane bismuth breast shielding could lower the radiation dose to the right breast by 22.76 %. The difference between the radiation doses of the shielded side of the breast and the unshieldeded side was found to be significant (p<0.001). No deterioration was detected in the image quality of the lung parenchyma on the side where bismuth shield was placed.Conclusions: In-plane bismuth shielding significantly reduces the radiation dose of the breast in pediatric female undergoing routine thoracic MSCT examination without impairing the image quality. [ABSTRACT FROM AUTHOR]

Introduction. Reconstructive surgery of abdominal aortic aneurysms, despite significant international experience, remains one of the most complex issues of current vascular surgery, especially due to anatomical variability of arterial blood supply of the kidneys and abnormalities in their development, among which the most common is a horseshoe kidney. Features of vascularization, placement of the renal isthmus relative to the main vessels, the choice of the optimal method of abdominal aortic aneurysm reconstruction cause a high risk of surgery. The issues of open and endovascular aortic grafting, possibility of crossing the isthmus of the horseshoe kidney, feasibility of reconstruction of additional renal arteries still remain controversial. The aim. Improvement of the diagnosis and surgical treatment of abdominal aortic aneurysms with a horseshoe kidney. Case presentation. In our observation, in a 61-year-old patient, by clinical examination, laboratory and diagnostic imaging the diagnosis of two infrarenal abdominal aortic aneurysms with a horseshoe kidney was confirmed, that has become a direct indication for surgical intervention: exclusion of infrarenal aortic aneurysms from the blood flow, abdominal aortic prosthetic grafting with reimplantation of the renal isthmus arteries into the prosthetic graft. This clinical case confirms the advantages of open surgical technique, using transperitoneal approach, which not only provided sufficient exposure of the operating area, but also allowed to perform optimal reconstruction of the abdominal aorta without crossing the functioning isthmus of the horseshoe kidney with preservation of blood flow through additional renal arteries. Conclusion. Careful preoperative assessment of the peculiarities of the blood supply of the horseshoe kidney with coexistent abdominal aortic aneurysms allows to optimize the tactics of surgical treatment, prevent the development of severe complications and achieve complete recovery of the patient.

Aim. To assess the relationship between the prevalence of visceral obesity (VO) and the severity of coronary calcification (CC) in patients with verified coronary artery disease (CAD). Materials and methods. 125 patients with CAD were examined. Assessment of the morphometric characteristics of visceral adipose tissue (VAT) and CC was perform using multislice computed tomography (MSCT). The calcium index (CI) of the coronary arteries (CA) was determine by the Agatston method. Statistical analysis was perform using Statistica 10.0. Results. VO was detect in 82 (65.6%) patients with CAD. In the presence of VO, higher CC values were observed in the projection of the envelope (p=0.00014), right coronary (p=0.00002) arteries, total CI (p=0.0003), and the prevalence of massive CC. Correlation analysis showed the relationship between the area of VAT and the CC of all the studied localizations. According to the ROC analysis, VO is a significant predictor of massive CC (area under the ROC curve AUC 0.72, 95% CI 0.560.89), in contrast to body mass index BMI (AUC 0.56, 95% CI 0.310.82). Conclusion. The index of the ratio of VAT to subcutaneous adipose tissue (VAT/SAT), but not BMI, had a direct correlation with CC. Morphology of VAT may be a significant diagnostic sign of massive CC in patients with CAD, as a factor affecting treatment and prognosis.

Objective: The orbit is an important cavity containing vision-related formations and important neurovascular structures, and adjacent to various regions. This study aimed to evaluation, by multidedector computed tomography (MDCT) images, the morphometry of orbit by examining its changes according to gender and body side, and developments according to age, in Turkish population. Materials and Methods: A total of 200 individuals's (94 females,106 males;400 sides) MDCT images were evaluated. Images were examined according to the gender, body side, and the anatomical structures development. Results: The height, width and depth of the orbit were determined as 36.04±2.97 mm, 32.33±2.59 mm, 38.35±3.32 mm on the right side, 35.79±3.18 mm, 32.29±2.67 mm, 38.13±3.21 mm on the left side, respectively, in healthy subjects. The height and width of the orbit were found to be statistically significantly larger on both sides in men than in women (p = 0.05). Conclusion: Comprehensive information about the orbit and associated apertures is quite important for clinicians working in this area, damage to these structures can cause serious complications. In addition, determining the morphometry of the orbit can be used as an important parameter for determining gender, age and race in forensic medicine. [ABSTRACT FROM AUTHOR]

Single-center comparison of postinterventional multislice computed tomography (MS-CT) and flat-detector computed tomography (FD-CT) in patients with subarachnoid haemorrhage (SAH) and endovascularly treated cerebral aneurysms with a focus on detection of posttherapeutical complications. Patients with endovascularly treated aneurysmal SAH undergoing both MS-CT and FD-CT within 24 h after intervention were included. Datasets were compared regarding image quality (IQ) as well as qualitative (detection of SAH, intracerebral haemorrhage [ICH], intraventricular haemorrhage [IVH], external ventricular drain [EVD] position, acute obstructive hydrocephalus [AOH]) and quantitative (cella media distance [CMD], modified Graeb score [GS]) parameters. 410 patients with endovascularly treated aneurysmal SAH were included. IQ was equal between MS-CT and FD-CT. FD-CT allowed equal detection of SAH and ICH in comparison to MS-CT. FD-CT allowed excellent detection of IVH and delineation of EVD position with strong agreement to MS-CT findings. FD-CT allowed equal detection of AOH in comparison to MS-CT. There was no significant difference of CMD and GS between FD-CT and MS-CT. Postinterventional FD-CT yields equivalent diagnostic value in patients with endovascular treated SAH as MS-CT. Enabling reliable detection of SAH-associated complications within the angiosuite, FD-CT might be an efficient and safe imaging modality in these clinical emergencies. [ABSTRACT FROM AUTHOR]

Background: Trials comparing non-vitamin K oral anticoagulant (NOAC) versus antiplatelet-based strategies have shown a reduction of subclinical leaflet thrombosis at the cost of increased mortality and major-bleedings. NOACs were often combined with antiplatelet therapy., Aims: The Rotterdam Edoxaban (REDOX) study aimed to evaluate the impact of edoxaban monotherapy on the incidence of hypo-attenuated leaflet thickening (HALT) and reduced leaflet motion (RLM) and to evaluate safety in terms of mortality, thromboembolic events and major bleeding., Methods: The REDOX study is a single-arm, open-label trial including patients after successful transcatheter aortic valve implantation (TAVI) with no formal indication for oral anticoagulation or dual antiplatelet therapy. Patients received edoxaban monotherapy for 3 months, followed by multislice computed tomography (MSCT). The primary endpoint was the occurrence of HALT. Clinical follow-up continued up to 1 year after TAVI., Results: We included 58 patients, of which 50 reached study completion including MSCT scanning and eight withdrew consent before end of study. At 3-months follow-up, HALT of any grade was detected in 12.0% (95% confidence interval (CI): 5.0%-23.1%) of patients. HALT grade ≥ 3 occurred in 4.0% (95% CI: 0.8%-12.2%) of patients. At 1 year follow-up, all patients were alive and free of disabling strokes. Three patients had a non-disabling stroke and one patient had a major bleeding., Conclusions: In the REDOX study, edoxaban monotherapy after TAVI was associated with a 12.0% incidence of any HALT and a 4.0% incidence of HALT grade ≥ 3. HALT was not associated with clinical events., (© 2024 Wiley Periodicals LLC.)

The aim of this study was to evaluate the effectiveness of MRI in diagnosing combined renal and ureteral injuries at different periods of traumatic disease (TD). Methods and Results: We analyzed the results of diagnostics and treatment of 139 patients (80 women and 59 men) with renal and ureteral injuries aged between 18 and 72 years. There were 67(48.2%) patients in the period of acute reaction to trauma, 40(28.8%) patients with early manifestations, and 32(23%) patients in the period of late manifestations. In 127(91.4%) patients, an urgent plain abdominal X-ray was performed without any preliminary preparation. USI of the abdominal and retroperitoneal space was performed in 108(77.7%) patients in the stage of the primary assessment of renal injury as it was a rapid non-invasive investigation. A whole-body MSCT was performed in 131(94.2%) patients, using the nonionic contrast agents Ultravist (350mg I/ml) and Omnipaque (350mg I/ml). MRI was performed in 125(89.9%) patients, including cases of pregnancy and a medical history of allergies. Contrast-enhanced MSCT had a high diagnostic efficiency in assessing complications in kidney and ureteral injuries at different periods of TD (accuracy of 89.2% for acute reaction, 88.8% for early manifestations, and 89.5% for late manifestations). MRI of the kidneys and ureters was indicated in periods of early and late manifestations of TB to detect renal complications in cases with a discrepancy between clinical manifestations and the results obtained by ultrasound and MSCT (accuracy of 87.5% for early manifestations and 89.9% for late manifestations).

Osteoarthritis (OA) is characterized by critical alterations of the subchondral bone microstructure, besides the well‐known cartilaginous changes. Clinical computed tomography (CT) detection of quantitative 3D microstructural subchondral bone parameters is applied to monitor changes of subchondral bone structure in different stages of human OA and is compared with micro‐CT, the gold standard. Determination by clinical CT (287 µm resolution) of key microstructural parameters in tibial plateaus with mild‐to‐moderate and severe OA reveals strong correlations to micro‐CT (35 µm), high inter‐ and intraobserver reliability, and small relative differences. In vivo, normal, mild‐to‐moderate, and severe OA are compared with clinical CT (331 µm). All approaches detect characteristic expanded trabecular structure in severe OA and fundamental microstructural correlations with clinical OA stage. Multivariate analyses at various in vivo and ex vivo imaging resolutions always reliably separate mild‐to‐moderate from severe OA (except mild‐to‐moderate OA from normal), revealing a striking similarity between 287 µm clinical and 35 µm micro‐CT. Thus, accurate structural measurements using clinical CT with a resolution near the trabecular dimensions are possible. Clinical CT offers an opportunity to quantitatively monitor subchondral bone microstructure in clinical and experimental settings as an advanced tool of investigating OA and other diseases affecting bone architecture. [ABSTRACT FROM AUTHOR]

Objectives: To compare the use of coronary computed tomography angiography (CCTA) between academic and non-academic sites across Europe over the last decade. Methods: We analyzed a large multicenter registry (ESCR MR/CT Registry) of stable symptomatic patients who received CCTA 01/2010–01/2020 at 47 (22%) academic and 165 (78%) non-academic sites across 19 European countries. We compared image quality, radiation dose, contrast-media-related adverse events, patient characteristics, CCTA findings, and downstream testing between academic and non-academic sites. Results: Among 64,317 included patients (41% female; 60 ± 13 years), academic sites accounted for most cases in 2010–2014 (52%), while non-academic sites dominated in 2015–2020 (71%). Despite less contemporary technology, non-academic sites maintained low radiation doses (4.76 [2.46–6.85] mSv) with a 30% decline of high-dose scans (> 7 mSv) over time. Academic and non-academic sites both reported diagnostic image quality in 98% of cases and low rate of scan-related adverse events (0.4%). Academic and non-academic sites examined similar patient populations (41% females both; age: 61 ± 14 vs. 60 ± 12 years; pretest probability for obstructive CAD: low 21% vs. 23%, intermediate 73% vs. 72%, high 6% both, CAD prevalence on CCTA: 40% vs. 41%). Nevertheless, non-academic sites referred more patients to non-invasive ischemia testing (6.5% vs. 4.2%) and invasive coronary angiography/surgery (8.5% vs. 5.6%). Conclusions: Non-academic and academic sites provide safe, high-quality CCTA across Europe, essential to successfully implement the recently updated guidelines for the diagnosis and management of chronic coronary syndromes. However, despite examining similar populations with comparable CAD prevalence, non-academic sites tend to refer more patients to downstream testing. Key Points: • Smaller non-academic providers increasingly use CCTA to rule out obstructive coronary artery disease. • Non-academic and academic sites provide comparably safe, high-quality CCTA across Europe. • Compared to academic sites, non-academic sites tend to refer more patients to downstream testing. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Oral carcinoma is one of the greatest health problems globally with increasing prevalence. It is the second most common malignancy in both genders in Pakistan. They are responsible for approximately 200,000 deaths per year worldwide. The most common malignancy of the oral cavity is squamous cell carcinoma (SCC). In a recent study bony invasion by squamous cell carcinoma is found to be 53.3% in mandible, 15.5% in maxilla and 4.4% in both. One of the important roles of imaging is to detect bony invasion of oral SCC. The management of these patients depend upon the bony invasion. This aim of this study is to evaluate the diagnostic accuracy of the computed tomography in detecting the bony invasion of oral squamous cell carcinoma. Early detection is of utmost important in planning the treatment regimen to reduce the risk of distant metastasis and consequent morbidity and mortality. MATERIAL AND METHODS: This was a prospective cross sectional study conducted at the department of diagnostic radiology, Ziauddin medical university and hospital. 211 patients were included in our study who has oral squamous cell carcinoma referred to our radiology department for imaging. Multislice computed tomography was done, and assessment was made for bone invasion of the tumor. Histopathology was done as the gold standard. Sensitivity & specificity were calculated by comparing the results with histopathology. RESULTS: The sensitivity and specificity of the computed tomography for the detection of bone invasion were 97.11% and 89.7% respectively. CONCLUSION: Mulltislice computed tomography is a noninvasive imaging modality in early detection of bony invasion of oral squamous cell carcinoma with high accuracy. CT reconstruction with bone algorithm is accurate technique in detection of bony invasion. [ABSTRACT FROM AUTHOR]

Background: The application of multislice spiral computed tomography (MSCT) scan has improved the diagnosis of small bowel diseases (SBDs). Objectives: This study aimed to develop a structured report (SR) template for SBDs based on MSCT scans and to compare its value with free-text reports (FTRs) by radiologists with different levels of seniority in radiology. Patients and Methods: A total of 120 SBD cases were confirmed based on the clinical manifestations, surgery, colonoscopy, and pathology. An SR template for small bowel imaging was developed, and six radiologists were divided into inexperienced and experienced groups. Sixty cases with small intestinal MSCT data were available for FTRs and another 60 cases for SRs after training. The report accuracy, satisfaction, and completion time were compared between the two reporting methods. Results: The writing time of SRs was significantly shorter than that of FTRs. By using FTRs, the experienced group showed higher levels of sensitivity for all diseases (i.e., intestinal wall, intestinal peripheral artery, blood vessel, bone, and other abdominal organ diseases) (P < 0.05). The experienced group showed a low misdiagnosis rate for all diseases (P < 0.05), except for bone disease (P = 0.161). By using SRs, the experienced group only showed a low misdiagnosis rate for the intestinal wall disease (P < 0.05). High sensitivity for the intestinal wall disease (P < 0.05) and intestinal peripheral artery disease (P = 0.024), along with improved sensitivity for bone lesions (P < 0.05), was reported in this group. In the inexperienced group, SRs improved sensitivity for all diseases (P < 0.05), except for intestinal wall disease (P > 0.05). The satisfaction scores for both inexperienced and experienced groups improved by using SRs (4 vs. 2.6 for the inexperienced group and 4.1 vs. 3.2 for the experienced group; P < 0.05 for both). Conclusion: The SRs were superior to FTRs in terms of writing efficiency, accuracy, and satisfaction. They could improve the accuracy of inexperienced radiologists in diagnosis and help detect SBDs. [ABSTRACT FROM AUTHOR]

Abstract Osteoarthritis (OA) is characterized by critical alterations of the subchondral bone microstructure, besides the well‐known cartilaginous changes. Clinical computed tomography (CT) detection of quantitative 3D microstructural subchondral bone parameters is applied to monitor changes of subchondral bone structure in different stages of human OA and is compared with micro‐CT, the gold standard. Determination by clinical CT (287 µm resolution) of key microstructural parameters in tibial plateaus with mild‐to‐moderate and severe OA reveals strong correlations to micro‐CT (35 µm), high inter‐ and intraobserver reliability, and small relative differences. In vivo, normal, mild‐to‐moderate, and severe OA are compared with clinical CT (331 µm). All approaches detect characteristic expanded trabecular structure in severe OA and fundamental microstructural correlations with clinical OA stage. Multivariate analyses at various in vivo and ex vivo imaging resolutions always reliably separate mild‐to‐moderate from severe OA (except mild‐to‐moderate OA from normal), revealing a striking similarity between 287 µm clinical and 35 µm micro‐CT. Thus, accurate structural measurements using clinical CT with a resolution near the trabecular dimensions are possible. Clinical CT offers an opportunity to quantitatively monitor subchondral bone microstructure in clinical and experimental settings as an advanced tool of investigating OA and other diseases affecting bone architecture.

The review considers the problem of choosing the optimal tactical approach to primary emergency radiation diagnosis of injuries during polytrauma based on data on indications for use, advantages and disadvantages of modern methods and protocols of radiation imaging. Literary sources were searched in the MedLine/ PubMed and eLibrary databases published from 2009 to 2019.The tactics of selective radiation diagnosis of polytrauma involves performing sequential studies (sonography, X-ray, computed tomography) of body areas in which damage is suspected by the mechanism of injury and clinical data, which limits the accuracy of the diagnosis and increases the duration of the examination. Primary multi-helical “whole-body”computed tomography including head, neck, chest, abdomen and pelvis examination, reduces the percentage of missed injuries, the duration of the examination and the time before emergency surgery, which can significantly reduce mortality in polytrauma. Its use is justified in patients with severe combined trauma if a high level of emergency hospital care organization is provided. Using “whole-body” computed tomography significantly increases the dose and economic costs, but the benefits of it for the survival of patients with polytrauma can outweigh the radiation risk and economic losses. Further development of technologies and protocols for multispiral computed tomography can significantly reduce the dose of radiation and the duration of the study. Clear and well-founded criteria for the selection of patients are needed for whom the use of “whole-body” computed tomography will be an effective strategy for radiation diagnosis.

Objective: The present study aimed to investigate the relation between abdominal aorta calcium score and renal stones (RS) using computed tomography (CT). Methods: This study comprised 352 subjects who underwent CT of urinary system in our clinic. One hundred and seventy-six subjects with RS were assigned to Group 1 and 176 subjects without RS were assigned to Group 2 (control group). The likely relation of calcium score, an indicator of atherosclerosis of abdominal aorta, with renal stone formation and stone volume, which has not been investigated previously, was investigated using multislice CT (MSCT). Results: Age distribution of the study subjects ranged from 19 years to 87 years (mean, 44.3±15.1 years). Of the study subjects, 224 (63.6%) were male and 128 (36.4%) were female. According to Agatston scoring, the mean aortic calcium score was 348.7±665.7 Agatston unit (AU) in Group 1 and 212.2±486.9 AU in Group 2. Stone volume was 38.1±25.7 cubic millimeter (mm3) in Group 1. Conclusions: Independently from RS volume, the frequency of abdominal aortic atherosclerosis was observed to be higher in the some aged patients with urolithiasis than in the normal subjects. The result was significant (p<0.05, p=0.029). [ABSTRACT FROM AUTHOR]

Alagille syndrome (AS) is an autosomal dominant multisystem disorder which can lead to hepatopathy and the development of focal hepatic lesions. The majority of the hepatic lesions are benign, including regenerative nodules, focal hyperplasia, and adenoma. Hepatocellular carcinoma (HCC) is extremely rare in AS, with very few cases reported in the literature. A 38-year-old man complaining of acute right upper quadrant pain with long-standing diagnosis of Alagille syndrome. On imaging, the patient had a large hepatic mass in the right lobe, with arterial hyperenhancement, washout appearance, and areas of internal hemorrhage. The patient underwent a right hepatectomy and histopathology demonstrated HCC. The patient passed away 3 months after the surgery due to infectious complications. HCC is a rare complication of AS, although rare, it should be considered. This case also emphasizes the need of HCC screening in patients with AS in order to allow an early diagnosis and treatment, which can improve patients’ outcome.

Purpose: Recurrent stroke is considered to increase the incidence of severe disability and death. For correct risk assessment and patient management it is essential to identify the origin of stroke at an early stage. Transthoracic echocardiography (TTE) is the initial standard of care for evaluating patients in whom a cardioembolic source of stroke (CES) is suspected but its diagnostic capability is limited. Transesophageal echocardiography (TEE) is considered as gold standard; however, this approach is time consuming, semi-invasive and not always feasible. We hypothesized that adding a delayed-phase cardiac computed tomography (cCT) to initial multimodal CT might represent a valid alternative to routine clinical echocardiographic work-up. Material and Methods: Patients with suspected acute cardioembolic stroke verified by initial multimodal CT and subsequently examined with cCT were included. The cCT was evaluated for presence of major CES and compared to routine clinical echocardiographic work-up. Results: In all, 102 patients with suspected acute CES underwent cCT. Among them 60 patients underwent routine work-up with echocardiography (50 TTE and only 10 TEE). By cCT 10/60 (16.7%) major CES were detected but only 4 (6.7%) were identified by echocardiography. All CES observed by echocardiography were also detected by cCT. In 8 of 36 patients in whom echocardiography was not performed cCT also revealed a major CES. Conclusion: These preliminary results show the potential diagnostic yield of delayed-phase cCT to detect major CES and therefore could accelerate decision-making to prevent recurrence stroke. To confirm these results larger studies with TEE as the reference standard and also compared to TTE would be necessary. [ABSTRACT FROM AUTHOR]

RELEVANCE. The dependency results of draining operations on the efficcacy of drainig of ductal system of the pancreas and adequate outflow of the pancreatic juce through anastomosis are undoubtful, therefore the development of new techniques of longitudinal pancreatojejunostomy (LPJ) extending area of anastomosis is an actual challenge.AIM OF STUDY. To compare the immediate and long-term results of longitudinal pancreatojejunostomy with the expansion of the area of anastomosis in patients with chronic pancreatitis.MATERIAL AND METHODS. We analysed immediate and long-term results of LPJ in 58 patients with chronic pancreatitis with impaired patency of the major pancreatic duct (MPD) without the head enlargement.RESULTS. All patients were divided into two groups: comparison group ( n=26, operated up to 2008 ) and main group (n=32, operated stumps during the MPD diastasis and posterior pancreatic surface (n=3) into anastomosis, with resection of the anterior pancreatic surface in the form of triangular fragments (n=11), with circulation of the small intestine loop during the recovery phase (n=19). The original LPJ in the study group of patients did not lengthened the surgery (160 [135, 185]) and intraoperative blood loss (265 [175, 340]). In the main group of patients there was no postoperative complications and fatal outcomes, but the average duration postoperative hospital treatment (18 [16; 20.5]) exceeded some data of foreign and domestic authors. Pain within 5 years after surgery in patients of the main group exceeded 26.6% and the appearance of diarrheal syndrome with dependance from reception of enzyme preparations was twice lower than in patients og the comparison group. According to questionnaire EORTC QLQ-C30, 5 years after surgery statistically significant differences between groups in terms of scales CF, NV, DY (p=0.03, 0.02, 0.006 respectively), indicating the advantage of intervention performed in the mail group.CONCLUSIONS. 1. An indication for longitudinal pancreatojejunostomy in chronic pancreatitis is impaired patency of the main pancreatic duct in the absence of an increase and inflammatory mass in the pancreatic head.2. The width of the main pancreatic duct is less than 5 mm and the presence of diastasis between its proximal and distal stumps with the posterior surface of the pancreas preserved, is not a reason for refusing longitudinal pancreatic jujunostomy in favor of the resection method.3. The expansion of pancreatojejunal anastomosis when performing longitudinal pancreatojejunostomy can improve the immediate and longterm results of surgical treatment for chronic pancreatitis.

Objective. To study the gluteal muscles in patients with scoliosis of various etiologies using multislice computed tomography (MSCT).Material and methods. MSCT was first used to study the gluteal muscles of 27 patients with idiopathic scoliosis. The patients were examined to study the vertebral column in order to determine a method and tactics for scoliosis treatment. The muscles were additionally examined using workstations and programs for MSCT data processing. In a control group of 18 patients with no clinical manifestations of spinal and hip joint abnormalities or those detected on CT, their gluteal muscles were examined due to their pelvic organ diseases.Results. Patients younger than 18 years of age who had spinal deformations of not more than 60 degrees had muscle changes as moderate hypotrophy, increased density, especially that of the gluteus medius muscle to 62.01 ± 7.20 HU. In patients over 18 years of age, the muscle density decreased at any magnitude of deformation and was the smaller the older patients were. In patients with spinal deformation greater than 90 degrees, the density of the gluteus maximus muscle on the convex side was significantly different from that on the concave side and was less on the concave side (p

Multiple primary colon cancer is an urgent medical problem of our time, which is associated with a steady increment in the incidence of the above disease and with the high complexity of its diagnosis. According to the literary sources, the incidence of this form of cancer of the colon has recently amounted to as much as 17% among all multiple primary neoplasms and this organ is a very common site. The paper describes a clinical case confirming the need for a thorough diagnosis of multiple primary colon cancer, by applying radiation techniques to further define treatment policies.

Abstract Background Atrial fibrillation (AF) affects millions of people worldwide and can remain undiagnosed for years. It is a major cause of cerebrovascular stroke (CVS); hence, early detection is extremely important in order to decrease the risk of CVS. We conducted a retrospective observational study looking into the prevalence of silent AF in 3299 patients admitted from January 2014 to December 2017 in a tertiary care stroke specialized center. Ischemic CVS was confirmed either by using multislice computed tomography (MSCT) or magnetic resonance imaging (MRI) of the brain. AF was diagnosed by electrocardiography (ECG) at the time of admission or during the hospital stay. Patients with a history of AF were excluded from the study. Results Of the 3299 patients admitted by acute ischemic CVS, 707 (21.43%) had a history of AF and thus were excluded from the study. Of the remaining 2592 patients eligible for the study, 1666 (64.27%) were males with a mean age of 56.06 years (± 16.01). A total of 2313 (89.24%) patients remained in sinus rhythm throughout the hospital stay, 211 (8.14%) patients were in AF on admission, and 68 (2.62 %) patients developed AF during their hospital stay. The total number of newly diagnosed patients with AF was 279 (10.76%). Conclusion The prevalence of de novo atrial fibrillation in patients presented with acute cerebrovascular stroke is high. The implementation of good screening programs can significantly reduce the risk of disabilities and morbidities.

Objectives: To evaluate the effect of different intraradicular posts on the dimensions of computed tomography (CT) images in cone-beam and fan-beam equipment. Materials and Methods: A total of 15 root canals of bovine teeth were instrumented up to a file #50 and root-filled by the active lateral condensation technique. The teeth were randomly divided into three groups, according to the type of intraradicular post: 1) tight fiberglass post; 2) anatomical fiberglass post; and 3) metal post. The root canals were desobturated in 10 mm and tomographic images were acquired in two devices, a cone-beam and fan-beam equipment. Then, the intraradicular posts were cemented using an automix self-conditioning and self-adhesive resin cement, and the final acquisitions of the CT images were performed for analysis. The diameter of the canal was compared before and after cementation of the intraradicular posts. The t-test was used between the initial and final measurements of each tomograph and also between the cone-beam and fan-beam tomographs (α = 0.05). Results: The anatomical fiberglass post presented the smallest dimensional change among the initial and final measurements, followed by the tight fiberglass post, with the metal post being the material that showed the most considerable dimensional difference in the cone-beam. Conclusion: All of the intraradicular posts used promoted a change in the size of the CT image. The fan-beam scanner promoted greater dimensional change in the images.

Objective: to determine treatment policy for an acute surgical disease in patients with late-stage HIV infection diagnosed using the data of the highly informative imaging techniques multislice computed tomography (MSCT) and magnetic resonance imaging (MRI). Material and methods. In 2008 and 2016, the authors examined 425 patients (320 men and 105 women) with acquired immunodeficiency syndrome (AIDS) who were treated at the surgical units of the Surgut Regional Clinical Hospital, by using the data of MSCT (Toshiba Aquilion 64, Japan) and MRI (Siemens 1,5T Magnetom Essenza, Germany) in identifying both local surgical and general mixed diseases.Results. Analysis of acute surgical diseases of the abdominal cavity and retroperitoneal space in patients with late-stage HIV infection determined that the treatment policy in this category of patients depended on clinical diagnostic data.Conclusions. 1. MSCT and MRI are highly informative techniques in diagnosing acute surgical diseases in patients with late-stage HIV infection. 2. The course of an acute surgical disease in patients with late-stage HIV infection in the presence of generalized opportunistic infection makes it preferable to perform minimally invasive surgical interventions.

Purpose: Cone beam computed tomography (CBCT) is increasingly overtaking multislice computed tomography (MSCT) for implant planning and computer-aided design/computer-assisted manufacturing (CAD/CAM) surgical guide fabrication. The purpose of this study was to evaluate whether the image modality has a significant influence on the accuracy of image-fusion stereolithographic guides. Materials and Methods: A total of 240 implants were placed in 30 polymer models using surgical guides fabricated using CBCT or MSCT and optical scanning of dental casts and diagnostic wax-up. Postsurgical image data were fused with the planning data for evaluation of the following errors: total error (Euclidean error), mesiodistal and buccolingual error, depth error, and angular error. The CBCT and MSCT results were statistically compared using a t test (P = .05). Results: CBCT showed a statistically significantly higher total error with mean (± SD) of 0.36 ± 0.13 mm vs 0.27 ± 0.13 mm (P = .000), mesiodistal error with 0.20 ± 0.14 mm vs 0.16 ± 0.11 mm (P = .018), and depth error with 0.17 ± 0.12 mm vs 0.07 ± 0.07 mm (P = .000). Buccolingual and angular errors did not statistically significantly differ with 0.16 ± 0.11 mm vs 0.15 ± 0.12 mm (P = .613), and 0.96 ± 0.47 degrees vs 0.85 ± 0.59 degrees (P = .111). Conclusion: Using CBCT for image-fusion stereolithographic guides may provide lower accuracy than MSCT. The results should be confirmed on alternative CBCT scanners. Due to the total volume of tissues, image artifacts, and patient movements, the advantages seen using MSCT on models could be nonexistent or exacerbated on patients. Patient studies are required to demonstrate clinical relevance. [ABSTRACT FROM AUTHOR]

BACKGROUND: Post-pericardiectomy right ventricular (RV) failure has been reported but it remains not well-studied. To investigate imaging parameters that could predict RV function and the outcome of patients post-pericardiectomy. METHODS: We analysed data from a total of 53 CP patients undergoing pericardiectomy. Preoperative, early and at 6 months postoperative echocardiographic (echo) imaging datasets were analysed and correlated with preoperative cardiac magnetic resonance (CMR), cardiac computed tomography scans and histology. The primary endpoint of the study was RV functional status early postoperatively and at 6 months. Secondary endpoint was the need for prolonged inotropic support. RESULTS: A cause of CP was identified in 26 patients (49%). Inotropic support = 48 hours was required in n = 28 (53%) of patients and was correlated with lower preoperative RV areas by echo or RV volumes by CMR (p < 0.05 for all). A pericardial score based on pericardial thickness/calcification and epicardial fat thickness had good diagnostic accuracy to identify patients requiring prolonged use of inotropes (area under the curve, 0.825; 95% confidence interval, 0.674-0.976). Pericardiectomy resulted in RV decompression and impaired RV function early postoperatively (fractional area change: 40.5% ± 8.8% preoperatively vs. 31.4% ± 10.4% early postoperatively vs. 42.5% ± 10.2% at 6 months, p < 0.001). CONCLUSIONS: We show that a smaller RV cavity size and a pericardial scoring system are associated with prolonged inotropic support in CP patients undergoing pericardiectomy. RV systolic impairment post decompression is present in most patients, but it is only transient. [ABSTRACT FROM AUTHOR]

Objective: The sphenoid sinus is a paranasal sinus that is extremely difficult to reach, being located deep in the skull and surrounded by a large number of vital neural and vascular structures. Additional radiological evaluation of the sphenoid sinus and related neurovascular structures is essential before surgery. This study aimed to analyze the anatomical variations associated with the neurovascular structures in and around the sphenoid sinus using multislice computed tomography (CT) and contribute to the literature by comparing the obtained data with previous studies. Material and Method: A total of 100 patients (50 females, 50 males) who underwent paranasal sinus CT for various rhinologic diseases were included in the study. Sphenoid sinus variations were evaluated as bone tissue anomalies and soft tissue pathologies on CT. Results: In this study, variations in the neurovascular borders of the sphenoid sinus were the most common findings. The variations related to the Vidian canal were most frequent with an incidence of approximately 73%, followed by those related to the optic nerve 55%, maxillary nerve 53%, and internal carotid artery 52%. Pneumatization of the pterygoid plate was observed in 59% of cases, pneumatization of the anterior clinoid process in 41%, and that of the greater wing of the sphenoid in 13%. Furthermore, 15% of the patients had onodi cells, 46% had multiple septations, 20% had mucosal thickening, 0.4% had polyps, and 0.3% had retention cysts. Conclusion: The structure of the sphenoid sinus is highly variable, and paranasal sinus CT is important in determining anatomic variations before sinonasal and transsphenoidal surgery and predicting possible complications during surgery. In this study, the variations of the sphenoid sinus were found at a higher rate compared to previous studies, which may be due to the differences in ethnic groups, CT imaging technique, or anatomical evaluation criteria. [ABSTRACT FROM AUTHOR]

Single-center comparison of postinterventional multislice computed tomography (MS-CT) and flat-detector computed tomography (FD-CT) in patients with subarachnoid haemorrhage (SAH) and endovascularly treated cerebral aneurysms with a focus on detection of posttherapeutical complications. Patients with endovascularly treated aneurysmal SAH undergoing both MS-CT and FD-CT within 24 h after intervention were included. Datasets were compared regarding image quality (IQ) as well as qualitative (detection of SAH, intracerebral haemorrhage [ICH], intraventricular haemorrhage [IVH], external ventricular drain [EVD] position, acute obstructive hydrocephalus [AOH]) and quantitative (cella media distance [CMD], modified Graeb score [GS]) parameters. 410 patients with endovascularly treated aneurysmal SAH were included. IQ was equal between MS-CT and FD-CT. FD-CT allowed equal detection of SAH and ICH in comparison to MS-CT. FD-CT allowed excellent detection of IVH and delineation of EVD position with strong agreement to MS-CT findings. FD-CT allowed equal detection of AOH in comparison to MS-CT. There was no significant difference of CMD and GS between FD-CT and MS-CT. Postinterventional FD-CT yields equivalent diagnostic value in patients with endovascular treated SAH as MS-CT. Enabling reliable detection of SAH-associated complications within the angiosuite, FD-CT might be an efficient and safe imaging modality in these clinical emergencies.

The bicuspid aortic valve (BAV) represents a complex anatomic scenario for transcatheter aortic valve replacement (TAVR) because of its unique technical challenges. As TAVR is moving towards younger and lower-risk populations, the proportion of BAV patients undergoing TAVR is expected to rise. Initial experiences of TAVR with first-generation transcatheter heart valves in high surgical risk patients with BAV stenosis showed higher rates of device failure and periprocedural complications as compared to tricuspid anatomy. The subsequent advances in imaging techniques and understanding of BAV anatomy, new iterations of transcatheter heart valves, and growing operators' experience yielded better outcomes. However, in the lack of randomized trials and rigorous evidence, the field of TAVR in BAV has been driven by empirical observations, with wide variability in transcatheter heart valve sizing and implantation techniques across different centers and operators. Thus, in this review article, we provide a fully illustrated overview of operative periprocedural steps for TAVR in BAV stenosis, though recognizing that it still remains anecdotal. [ABSTRACT FROM AUTHOR]

A congenital diaphragmatic hernia is very uncommon among adults. A diaphragmatic hernia is primarily acute in onset and it is usually identified after trauma. It occurs mostly on the left side. We would like to report a 68-year-old male who presented with a 4-day history of acute intestinal obstruction with a background history of change in bowel habit for a month secondary to a rightdiaphragmatic hernia. He did not have any history of trauma. Clinical examination revealed a distended abdomen with high pitched bowel sound and no palpable mass. The right lung was inaudible on auscultation. Computed tomography scan was consistent with a right diaphragmatic hernia and acute intestinal obstruction. We highlight the late onset of a congenital diaphragmatic hernia and emphasize the vital need for perioperative management to ensure a promising surgical outcome. [ABSTRACT FROM AUTHOR]