Anatomic assessment of the left main bifurcation and dynamic bifurcation angles using computed tomography angiography.

BACKGROUND: An understanding of the left main coronary artery (LMCA) anatomy is important for accurate diagnosis and therapy. We aimed to investigate LMCA anatomy via 128-multisliced coronary computed-tomography-angiography (CCTA) in patients with normal LMCA. MATERIALS AND METHODS: A total of 201 CCTA studies were included in this study. Anatomical features of LMCA including cross-sectional areas of the LMCA ostial, LMCA distal, left anterior descending artery (LAD) ostial and left circumflex artery (LCX) ostial, and degree of tapering and LMCA bifurcation angles (BA) in the form of LMCA-LCX BA, LMCA-LAD BA, LAD-LCX BA at end-diastole and end-systole. RESULTS: The mean age was 55 ± 11; 55.7% of patients were males. Right coronary artery was dominant in 173 (86.1%) patients. Mean LMCA length was 10.0 ± 4.5 mm. The mean values of LMCA ostial, LMCA distal, LAD ostial and LCX ostial areas were 18.2 ± 5.1 mm², 13.2 ± 4.0 mm², 9.0 ± 3.2 mm² and 7.6 ± ± 2.8 mm², respectively. LMCA ostial-distal area, LMCA distal-LAD ostial area and LMCA distal-LCX ostial area ratios were ≥ 1.44 - < 1.69 in 47 (23.4%), 53 (26.4%), 47 (23.4%) patients, respectively, and were ≥ 1.69 - < 1.96 in 19 (9.5%), 24 (11.9%), 40 (19.9%) patients respectively. Systolic motion modifies LMCA BAs; systolic motion begets an increment of LMCA-LAD angle in 72.6% of patients and decrement of LAD-LCX angle in 75.6% of patients. Patients with T-shaped LAD-LCX BA was shown to have significantly longer LMCA, larger LAD ostial area, larger LCX ostial area and higher diastolic-to-systolic range (DSR) of LAD-LCX BA compared to patients with Y-shaped LAD-LCX BA. CONCLUSIONS: LMCA with T-shaped distal BA was found to have significantly longer LMCA, larger LAD ostial area, larger LCX ostial area and higher DSR of distal BA compared to patients with Y-shaped distal BA. These findings may provide useful information for LMCA bifurcation stenting or designing dedicated stents for LMCA.

Evaluation of vertebral artery dominance, hypoplasia and variations in the origin: angiographic study in 254 patients.

BACKGROUND: The aim of this study was to determine the dimensional characteristics and variations in the origin of vertebral arteries (VA). MATERIALS AND METHODS: We retrospectively reviewed angiographic studies in 254 patients (133 males, 121 females) for the evaluation of diameter differences in VA. We examined different criteria from the literature (difference of ≥ 0.3 mm, ≥ 0.8 mm, ≥ 1 mm between the widths of two VA and diameter ratio more than 1.4) to find out the dominant VA, rate of co-dominance and hypoplasia. The differences among groups were analysed using the c2 and Kruskal-Wallis test. Also concordance analysis test was used to determine correspondence between the tests. We also noticed the variations in the origin of VA. RESULTS: The average diameter of VA in 254 patients was 3.21 ± 0.7 mm on the right, and 3.16 ± 0.7 mm on the left. The average diameter difference was found 0.88 ± 0.7 mm. The rate of hypoplasia was found 7.1% on the right and 9.4% on the left. Among 254 patients according to the criterion of any diameter difference; right side was found wider in 126 (49.6%) patients and left side was found wider in 120 (47.2%) patients. The criterion of 0.3 mm or greater difference showed right VA dominance in 107 (42.1%) patients, left VA dominance in 99 (39%) patients. Co-dominance was mainly observed when we used the criteria of 0.8 mm and 1 mm or greater difference and diameter ratio more than 1.4. We found out harmony of two criterion of difference of ≥ 0.8 mm and ≥ 1 mm (concordance analysis test, 76.1%). There was no statistically significant relation between age, gender and any dominance criteria (p > 0.05). The majority of VA showed classical origin arising from both subclavian arteries with a rate of 94.9%. CONCLUSIONS: The most striking result we have found is the dominance of the right VA in diameter by using all different criteria unlike with previous reports in the literature.

Anthropometric measurements of the orbita and gender prediction with three-dimensional computed tomography images.

BACKGROUND: The aim of the study was to investigate the orbital anthropometric variations in the normal population using three-dimensional computed tomography (3D-CT) images and to define the effects of age and gender on orbital anthropometry. MATERIALS AND METHODS: Three-dimensional orbita CT of 280 patients, obtained for various reasons, were retrospectively evaluated in 772-bed referral and tertiary-care hospital between April 2011 and June 2012. Using 3D images, orbital width, height, biorbital-interorbital diameter and orbital index were measured. Measurements were obtained comparing right and left sides and male to female. The relation of the results with age and gender was analysed. RESULTS: Right orbit was found to be wider than left (p < 0.0001). Male patients had wider (p < 0.0001) and higher (p = 0.0001) orbits. Right orbital index was found to be smaller than the left one (p = 0.005). No differences were found between the genders in terms of right and left orbital indexes (p > 0.05). Biorbital (p < 0.0001) and interorbital (p = 0.01) widths were found to be higher in males. There was no relation between the age change and the parameters defined (p > 0.05). CONCLUSIONS: No relation was found between age and orbital measurements. It was concluded that orbital images obtained with 3D-CT may be used as a method for gender evaluation.

Acute muscle loss and early effects of COVID-19 on skeletal muscle in adult patients: A retrospective cohort study.

OBJECTIVES: It is known that COVID-19 has multisystemic effects. However, its early effects on muscle tissue have not been clearly elucidated. The aim of this study is to investigate early changes in the pectoral muscle in patients with COVID-19 infection. MATERIALS AND METHODS: The pectoral muscle areas (PMA) and pectoral muscle index (PMI) of 139 patients diagnosed with COVID-19 were measured from chest CTs taken at the time of the first diagnosis and within 6 months after the diagnosis. The effect of the infection on the muscle area was investigated by evaluating whether there was a change between the two measurements. Lung involvement of the infection in the first CT was scored with the CT severity score (CT-SS). In addition, the effects of patients' clinics, CT-SS, length of hospital stay, and intubation history on changes in the muscle area were investigated. RESULTS: When the PMA and PMI values were compared, there was a statistically significant decrease in the values in the control CT group compared to the first diagnosis CT group. The difference was found higher in intubated patients. CT-SS was associated with a decrease in PMI. CONCLUSION: COVID-19 is one of the causes of acute sarcopenia. Pectoralis muscle is part of the skeletal muscle, and there may be a decrease in the muscle area in the early period of the disease.

Percutaneous treatment of giant abdominal hydatid cysts: long-term results.

BACKGROUND: This study aimed to evaluate the efficacy of percutaneous treatment of giant abdominal hydatid cysts. METHODS: In this study, 15 abdominal giant hydatid cysts were treated with the catheterization technique, which included puncture of the cyst, aspiration of fluid, instillation and respiration of hypertonic saline solution, and catheterization and sclerosant therapy with absolute ethanol followed by free drainage of the cavity. The catheter was removed when the daily drainage was less than 10 ml. RESULTS: The goals, including inactivation of the parasite and elimination of the mass effect, were achieved in all patients. Catheterization required a mean of 32 days (range, 14-52 days) and hospitalization a mean of 8.73 days (range, 2-30 days). No evidence for recurrence was observed in any patient during a mean follow-up period of 52.8 months (range, 36-72 months). CONCLUSION: Percutaneous treatment of giant hydatid cysts is effective because it eliminates both the mass effect and the parasite and alleviates the symptoms. Although the long catheterization time associated with the procedure is unfavorable, it is tolerated by the patients.

Mammographic and Ultrasonographic Findings of Different Breast Adenosis Lesions.

Aim: To describe imaging features of different breast adenosis lesions. Materials and methods: Mammographic and ultrasonographic findings of patients with different types of adenosis were reviewed retrospectively Tissue samples were obtained either with US-guided core needle biopsy or localization with needle-wire system and surgical excision. Results: Forty-three adenosis lesions were diagnosed in 41 patients: 27 sclerosing adenosis, 13 blunt duct adenosis and 3 microglandular adenosis. Most frequent abnormal findings of sclerosing adenosis were masses with non-circumscribed margins and focal acoustic shadowing without mass configuration (54%) on ultrasonography. Mammography was normal in 54% of sclerosing adenosis, the most common abnormality was architectural distortion (21%). In blunt duct adenosis, usually circumscribed masses (46%) were detected on ultrasonography, clustered punctate microcalcifications (23%) and circumscribed masses (23%) were observed on mammography. All microglandular adenosis lesions were non-circumscribed masses. Premalignant components were detected only with surgical excisional biopsy in three patients that showed suspicious radiological findings and benign pathological result on core biopsy. Conclusion: The adenosis lesions have no pathognomonic characteristics on mammography and ultrasound. Total excision may be considered when suspicious radiological findings are present although core needle biopsy results are benign.

Detection of prostatic carcinoma: the role of TRUS, TRUS guided biopsy, digital rectal examination, PSA and PSA density.

The purpose of this study was to evaluate the efficacy of various diagnostic tests including transrectal ultrasound (TRUS), TRUS guided biopsy, digital rectal examination (DRE), prostate specific antigen (PSA), and prostate specific antigen density (PSAD) in detecting prostatic carcinomas. One hundred and thirty-four men underwent TRUS guided random, or directed and random sonographic biopsies of the prostate. The mean age was 64.67 (range, 31- 88) years. Indications for biopsy were abnormal findings suggesting prostatic carcinoma on DRE or increased levels of PSA, defined as 4.0 ng/ml or greater in a monoclonal antibody assay. PSAD was calculated by dividing the serum PSA in ng/ml to the volume of the entire prostate in cm3. The biopsy results were grouped as benign, malign and, prostatitis. The patients were also divided into three groups according to their PSA values. Of the 134 patients evaluated, 31 (23.1%) had prostate adenocarcinoma, 89 (66.4%) had benign prostatic tissue, hyperplasia or prostatic intraepithelial neoplasia, and 14 (10.4%) had prostatitis. The mean PSA and PSAD of the carcinoma group were significantly higher than those of the noncancer group. In the group of patients with PSA levels between 4 and 10 ng/ml, abnormal TRUS or DRE increased cancer detection rate, where neither PSA nor PSAD was capable of discriminating the patients with and without cancer. PSAD did not prove to be superior to the other diagnostic tests in this study. We recommend biopsy when either TRUS or DRE is abnormal in patients with PSA levels between 4 and 10 ng/ml. In the patients with PSA levels greater than 10 ng/ml, biopsy is indicated whatever the findings on TRUS or DRE are, since cancer detection rate is high.

A case of a rare aortic arch variation: the avian form.

Variations in the branching pattern of the aortic arch are multiple. The avian form is an extremely rare anatomical variation with only a few reported cases in the literature. Herein we report a case of avian variation with two branches arising from the aortic arch: a bicarotid trunk and a common origin for bilateral subclavian arteries.

Radiologic findings and percutaneous treatment of a rare giant soft tissue hydatid cyst.

The aim of this report is to present the radiologic findings and discuss the percutaneous treatment of an extremely rare giant soft tissue hydatid cyst located in the left thigh in a 44-year-old woman. Ultrasound showed a well circumscribed giant soft tissue cyst, and computed tomography revealed a well defined unilocular hypodense cystic mass originating from the adductor muscles and extending through the subcutaneous tissue without bony relations. On magnetic resonance imaging, the cystic mass was hypointense on T1 and hyperintense on T2-weighted images. Percutaneous treatment was performed successfully by catheterization technique with hypertonic saline and alcohol. No complications and recurrence were observed during the procedure, in the postprocedure or in the follow up period.

The association of intramammarian arterial calcifications detected on mammography with coronary artery disease and its risk factors.

AIM OF THE STUDY: To evaluate the association of intramammarian arterial calcifications seen on mammography with coronary artery disease and its risk factors and to discuss intramammarian arterial calcifications value as a predictor of coronary artery disease. MATERIAL AND METHODS: Mammography was performed on 55 women over 40 years of age who have undergone coronary angiography and have not had a mammography in the past year. Coronary angiography results, coronary artery disease risk factors and intramammarian arterial calcifications are evaluated. RESULTS: The prevalance of intramammarian arterial calcifications was 41.8%. A significant relationship between intramammarian arterial calcifications and coronary artery disease was indicated (OR 10,8, 95% Cl 3,02-38,59). The positive predictive value and negative predictive value of intramammarian arterial calcifications for coronary artery disease was 78.3% and 75% respectively. Also advancing age was found relevant with these calcifications (OR 1,15, 95% Cl 1,05-1,25). CONCLUSION: The results support the present literature and suggest that mammography, already widely in use as a screening tool among women over 40, may be used simultaneously in coronary artery disease risk assessment. These results should be confirmed by further larger group controlled studies.

The value of proton MR-spectroscopy in the differentiation of brain tumours from non-neoplastic brain lesions.

PURPOSE: Our aim was to evaluate the efficacy of Proton-MR Spectroscopy for the differentiation of cranial masses from non-neoplastic brain disorders. MATERIAL AND METHOD: 33 patients with intracranial mass lesions, 29 patients with non-neoplastic brain lesions: Ischemic-demyelinating-metabolic-benign cystic mass group; As a whole 62 patients: 30 males and 32 females were included in this study. RESULTS: In brain tumours, average Cho/NAA ratio 2.84-NAA/Cr ratio was 0.97, Cho/Cr ratio 2.42 and Cho/MI ratio was 3.51. In non-neoplastic group; NAA/Cr ratio was extremely higher than tumour group, the other ratios were far lower than cranial mass lesions. Average Cho/NAA ratio: 0.50 +/- 0.15, Cho/Cr ratio: 1.05 +/- 0.14, Cho/MI ratio: 1.07 +/- 0.73. CONCLUSION: Higher Cho/NAA and Cho/MI ratios with lower NAA/Cr ratio were most likely to be malignant. Additional lipid and lactate peaks were generally seen in malignant group.

Pathologic assessment of non-palpable probably benign breast masses at sonography: can instant intervention be avoided and is follow-up adequate?

AIM OF THE STUDY: To evaluate the pathologic results, determine the negative predictive value of non-palpable probably benign lesions at ultrasound and asses whether follow-up is adequate and immediate biopsy can be avoided. MATERIALS AND METHODS: Four hundred and eight cases which were referred to our breast imaging unit between 2004 and 2008 for biopsy evaluation were enrolled into the study. Two hundred and thirteen probably benign solid masses are classified as BI-RADS 3 in 205 of the enrollees. All masses were sonographically detectable and were classified through the guidelines of BI-RADS lexicon for sonography before the final pathological examination. All pathologic results were evaluated and the negative predictive value, false negativity rate and 95% confidence interval were calculated. RESULTS: Of the 213 masses, fine needle aspiration cytology was performed in 120. US-guided wire localization and eventual surgery were carried out in the remaining 93 masses. Finally, 211 of the punctured lesions turned out to be benign and only two malignant lesions were detected. The resulting negative predictive value was found to be 99.1% while the false negative rate value was 0.9%. CONCLUSION: With the results provided, we think that in the patients with sonographically detected probably benign breast lesions, short-term follow-up seems to be a strong alternative to immediate biopsy with its reliable high negative predictivity as well as low false negativity.

Intravascular papillary endothelial hyperplasia (Masson's hemangioma) presenting as a lateral neck mass.

Intravascular papillary endothelial hyperplasia (Masson's hemangioma) is a benign disease of vascular origin characterized by exuberant endothelial proliferation in normal blood vessels.The most important feature of the disease is its resemblance to hemangiosarcoma and the resulting possible radiologic misinterpretation. We present the radiologic findings in a 45-year-old woman presenting a neck mass extending to the thoracic cavity.

Pictorial essay. Various locations of cystic and alveolar hydatid disease: CT appearances.

Hydatid disease (echinococcosis) is a parasitic infection caused by the larval stage of the tapeworm Echinococcus. In humans, the two main forms are cystic hydatid disease, caused by E. granulosus, and less frequently alveolar hydatid disease, caused by E. multilocularis. They can be found in various sites in the body. The purpose of this essay is to illustrate the CT appearances of cystic and alveolar hydatid disease in various locations.

CT findings in skeletal cystic echinococcosis.

PURPOSE: To evaluate the CT findings of skeletal cystic echinococcosis. MATERIAL AND METHODS: CT findings of 7 patients with pathologically confirmed skeletal cystic echinococcosis were evaluated. RESULTS: There were 4 men and 3 women, aged 36-75 years. Hydatid cysts were located in the spine (n=2), a rib (n=3), the pelvis and a vertebra (n=1), the pelvis and the left femur (n=1). The size of the lesions varied from 1 cm to 15 cm. CT showed well defined, single or multiple cystic lesions with no contrast enhancement, no calcification, no daughter cysts, and no germinal membrane detachment. The cystic lesion had a honeycomb appearance in 2 cases; there was pathologic fracture in 2 cases, bone expansion in 5 cases, cortical thinning in 6 cases, cortical destruction in 6 cases, bone sclerosis in 1 case, and soft tissue extension in 6 cases. CONCLUSION: Preoperative differential diagnosis of skeletal cystic lesions should include cystic echinococcosis, especially in endemic areas, since this diagnosis may easily be missed unless kept in mind.

Various diffuse infiltrative lung diseases: high resolution computed tomography appearances.

High resolution CT (HRCT; 1-2 mm collimation scans reconstructed with a high spatial frequency algorithm) is an established technique for the evaluation of diffuse infiltrative lung diseases. For many of these diseases, the features shown on HRCT correlate well with the histopathological abnormalities. The purpose of this pictorial essay is to illustrate HRCT appearances in various diffuse infiltrative lung diseases.