Coronary artery calcium score above 250 confirms the presence of significant stenosis in coronary CT angiography of symptomatic patients.

OBJECTIVES: Evaluation of coronary artery calcium score (CACS) at multiple low and high cutoff values for the detection of significant coronary stenosis at two different cutoffs (50 and 70%) in a large number of symptomatic patients was not investigated previously in one study. This study aims to investigate if there are a correlation and statistical significance between different CACS cutoffs and the severity of coronary artery stenosis by coronary CT angiography (CCTA) in symptomatic patients. METHODS: This is a retrospective study that included all symptomatic patients who had CCTA in a tertiary care hospital over a period of 7 years. RESULTS: CCTA of 502 patients was evaluated (406 included, mean age 56.2 years); 230 were males (56.7%). The prevalence of stenosis at any percentage was 53.7%, ≥50% was 26.6% and ≥70% was 12.3%. The mean CACS was 84.5 (range 0-1860), for males was 124.5 and for females was 32.1. Patients with CACS of zero (59%) and CACS of ≥1 (41%) had a mean stenosis of 8.9% (range 0-75%) and 52.6% (range 0-100%), respectively. All patients with a CACS of ≥250 were found to have ≥50% stenosis (100% specificity and positive predictive value, 35.2% sensitivity, 81% negative predictive value and 82.6% accuracy). The percentage of stenosis increased as CACS increased with strong statistical significance (P value < 0.0001) and a positive correlation (r = 0.58). CONCLUSIONS: CACS is a valuable diagnostic tool to predict the severity of coronary artery stenosis. A cutoff value of 250 confirmed the presence of at least 50% stenosis in symptomatic patients.

Western-designed total knee implants mismatch Saudi patient knees. Anatomical bony measurements documented by computed tomography.

OBJECTIVES: To determine the anthropometric features of Saudi knees compared with knees of other ethnicities and reveal mismatches among different knee implant systems. METHODS: All knee computed tomography images obtained between January 2016 and September 2016 for varying medical reasons in a tertiary care hospital in Southwestern Saudi Arabia were retrospectively evaluated. Patients aged less than 18 years, with trauma or soft tissue or bone tumors were excluded.  Eleven parameters were measured for each knee joint. RESULTS: We evaluated 100 knees of 50 Saudi patients (25 men, 25 women) aged 28-85 (mean, 57.3) years. No statistically significant differences were found in age and Sasaki angle measurements between male and female patients. All other parameters were significantly larger in male than female knees. Our measurements were close to those published for Chinese, Thai, and Korean patients; however, published measurements were larger for Caucasian and Indian knees than our measurements. CONCLUSION: The Saudi population has morphological features of knee bone anatomy that do not match with the widely available prostheses designed for Caucasian knees. As several studies of different ethnicities have documented considerable prosthesis mismatch; our study further indicates the need for new implant designs that take these variations into account.

Awareness of interventional radiology among final-year medical students and medical interns at a university in Southwestern Saudi Arabia.

OBJECTIVE: To assess the awareness of interventional radiology (IR) among final-year medical students and medical interns at a Saudi University. Analysis of such awareness could help to improve the future of IR in Saudi Arabia. METHODS: This cross-sectional study was based on anonymous surveys administered over a one month period (1st-31st December 2012). One hundred and nineteen medical students and interns of King Khalid University, Abha, Saudi Arabia were included. Forty-two (35.3%) replies were received. The survey consisted of 25 questions covering perception, knowledge, and interest of interventional radiology. RESULTS: The majority of the respondents (52%) felt their knowledge in IR is poor. Only 40% of the respondents either completed or plan to complete an elective rotation in radiology. Thirty-eight percent of respondents were willing to consider a career in IR. The most common reason (43%) for not considering a career in IR was lack of knowledge. Only 33% correctly identified the route of training of interventional radiologist. The majority of respondents thought that interventional radiologists performed cardiac angioplasty (81%), and femoral popliteal bypass (74%). CONCLUSION: Exposure to IR among medical students and interns was poor. This can be addressed by dedicated undergraduate teaching of IR by interventional radiologists with emphasis on the clinical practice.

Intralobar pulmonary sequestration presenting as a large multicystic mass.

A large multicystic mass lesion is not a common presentation of pulmonary sequestration. This presentation may result in failure to identify the supplying systemic artery due to multiplicity of the large cysts and, therefore, a wrong diagnosis. We discuss a case of intralobar pulmonary sequestration presented similarly. Chest x-ray and CT appearance gave an initial impression of hydatid disease which is endemic in Saudi Arabia. Fortunately, the supplying systemic artery was identified in the final CT review before surgery. Preoperative correct diagnosis of pulmonary sequestration is important to plan the appropriate surgery and to prevent possible intractable intraoperative hemorrhage. Awareness of this uncommon presentation of pulmonary sequestration helps to prevent such a fatal complication.