Tibiofibular relationships of the normal syndesmosis on axial computed tomography in the Turkish population.

OBJECTIVE: Computed tomography (CT) is superior to plain radiography for evaluating ankle syndesmosis, but anatomic variations can affect the measurements. This study aimed to assess the radiological parameters of incisura fibularis and the factors that could affect these parameters. MATERIALS AND METHODS: Lower extremity CT angiography images were used to evaluate the morphology of the incisura fibularis, anterior/posterior tibiofibular distance, longitudinal/transverse length of the distal fibula, length/depth of the incisura fibularis notch, tibiofibular clear space, tibiofibular overlap, and fibular rotation. Each measured parameter was compared based on gender and body sides. Also, the effect of age, height, weight, and body mass index (BMI) on parameters was evaluated. RESULTS: A total of 123 patients (83 males, 40 females) were included, and 246 ankles were measured. CT measurements demonstrated excellent intra-observer and interobserver reliability. No significant gender or side differences were found in tibiofibular overlap (TFO) and tibiofibular clear space (TFCS), the most used parameters in x-rays. Age, weight, and BMI were found to be correlated with TFO. CONCLUSIONS: The present study has provided CT measurements of the normal tibiofibular syndesmosis in the Turkish population. Also, the correlations of the parameters with age, height, weight, and BMI were presented. Therefore, TFO and TFCS of the uninjured side can be used to plan the treatment of ankle injuries.

Pancreatosteatosis in patients with adrenal incidentaloma: A risk factor for impaired glucose metabolism.

AIMS: Patients with adrenal incidentaloma (AI) are at increased risk of impaired glucose metabolism, which is known to be associated with pancreatosteatosis (PS). We aimed to investigate the risk of developing dysglycemia for patients with non-functioning AI (NFAI) versus those without, and whether the presence of PS predicts future dysglycemia in patients with NFAI. METHOD: In 80 patients with NFAI and 127 controls matched for age, sex, and body mass index, changes in fasting plasma glucose (FPG) and hemoglobin A1c(HbA1c) were evaluated at 2 years. PS was evaluated with data obtained from non-contrast abdominal computed tomography (CT) performed at the initial evaluation. RESULTS: Mean FPG levels increased significantly after 2 years in both groups (P < 0.001, for both), albeit significantly higher among patients than the controls (P = 0.002). The increases in HbA1c and FPG levels were significantly higher among patients with PS than without PS, in the adenoma group (p < 0.001, P = 0.00, respectively). The change in Hba1c levels was associated with the presence of PS in patients with NFAI (p < 0.001). CONCLUSIONS: Our findings suggest that the presence of PS may provide significant information in predicting newly developed dysglycemia in patients with NFAI.

The Effectiveness of Prostate Imaging and Reporting and Data System Version 2 in the Diagnosis of Prostate Cancer with Screening Parameters Correlation.

PURPOSE: Prostate cancer is the most commonly diagnosed cancer and the second most common reason for cancer-related mortality in men. The purpose of cancer screening is to detect the disease at an early stage to help effective treatment. This study aimed to investigate the effectiveness of MRI and PI-RADS in the diagnosis of prostate cancer and examine the relation between screening parameters with prostate cancer. METHODS: The PACS system was analyzed and MRI images between September 2016 and April 2018 were listed. The state of patients regarding having pathology results were obtained. PSA values were listed. The prostate volume and the prostate density was calculated. PI-RADS assessment was used for each prostate lesion. RESULTS: Data of 138 patients were included in the study. The mean age was 63±8.9. The mean prostate gland volume was 63.8±39.3ml, the mean PSA value was 12.51±25.22 and the mean PSA density was calculated as 0.319±0.945. A statistically significant difference was found between age and prostate volume and cancer. The age of the cancer cases was higher than those who did not have cancer (p<0.05). A negative correlation was found between prostate volume and cancer status. The prostate volume of non-cancer cases was higher compared to cancer cases (p=0.0001). 55 patients had no malignancy. It was observed that 56.4% of cancer patients had significant cancer. The frequency of using PI-RADS scores was 4% for P1, 36% for P2, 14% for P3, 28% for P4, and 18% for P5. Clinically significant cancer was present in 57.9% of patients with PI-RADS score4 and 69.6% of patients with PI-RADS score5. It was found that diagnostic values were significantly high for prostate cancer screening in patients with PI-RADS scores4 and 5 (Sensitivity 76.4%, Specificity 73.5%, Negative predictive value 82.4%, Positive predictive value 65.6%). CONCLUSION: PI-RADS and MRI can be useful for the diagnosis of the clinically significant prostate cancer in patients at risk for prostate cancer. It is a non-invasive, repeatable method for prostate cancer screening and diagnosis. In prostate screening PSA reliability may be questioned. Additional methods are needed for the diagnosis. For this reason MRI and PI-RADSv2 is an effective predictor of prostate cancer in patients with high PSA levels.

Correlation of Morphological and Functional Cardiac Images: Fusion of Myocardial Perfusion SPECT and CT Angiography.

Objectives: The current study evaluates the value of cardiac hybrid imaging (CHI), performed by the fusion of functional and anatomic cardiac images, in the detection of hemodynamically significant coronary stenosis in cases with multiple coronary stenosis. Methods: A total of 36 patients (10 female, 26 male) in whom ischemia or infarction was detected on gated myocardial perfusion single photon emission computed tomography (gMPS) and multiple coronary stenosis were concomitantly detected on coronary computed tomography angiography (CCTA) and undergone invasive coronary angiography (ICA) was included in this study. Statistical analyses were performed using SPSS 22 Windows software. McNemar test was applied to show concordance between coronary CT angiography, ICA and CHI in the detection of anatomically or hemodynamically significant stenosis in three major coronary arteries. Comparison results of coronary arteries responsible for perfusion defects on CHI and gMPS are presented as percentages (%). Results: There was total accordance between coronary arteries leading to perfusion defects detected by gMPS and CHI in 50% of patients. It was observed a partial accordance in 36.1% of the patients. Additionally, it was also detected perfusion defects originated from side branches in 25% of the patients. Between results of CCTA and ICA, no statistically significant difference was noted in the detection of anatomically significant stenoses in the left main coronary artery, left anterior descending artery (LAD), left circumflex artery (LCx) and right coronary artery (RCA) (p=1.000, 0.070, 0.549, and 1.000, respectively). In addition, no statistically significant difference was found in the detection of anatomically and hemodynamically significant stenoses in LAD, LCx and RCA by CCTA and CHI (p=0.344, 0.629, and 0.219, respectively). No statistically significant difference was observed in the detection of anatomically and hemodynamically significant stenoses in LAD, LCx and RCA by ICA and CHI (p=0.804, 1.000, and 0.344, respectively). Conclusion: It is possible to detect hemodynamically significant coronary stenosis directly by CHI modality in patients with multiple coronary stenosis, wide perfusion defects.

Relationship between chest computed tomography findings and clinical conditions of coronavirus disease (COVID-19): A multicentre experience.

AIMS: This study aimed to investigate the clinical and chest computed tomography (CT) features associated with clinical parameters for coronavirus disease (COVID-19) in the capital of Turkey, Ankara. MATERIALS AND METHODS: Epidemiological, clinical features, laboratory findings and radiological characteristics of 1563 hospitalised patients with COVID-19 in Ankara were collected, reviewed and analysed in this study. The risk factors associated with disease severity were investigated. RESULTS: Non-severe (1214; 77.7%) and severe cases (349; 22.3%) were enrolled in the study. Compared with the non-severe group, the severe group were significantly older and had more comorbidities (ie, hypertension, diabetes mellitus, cardiovascular disease and chronic kidney disease). Smoking was more common in the severe group. Severe patients had higher respiratory rates and higher incidences of cough and dyspnoea compared with non-severe patients. Compared with the non-severe patients, the severe patients had increased C-reactive protein (CRP), procalcitonin, neutrophil to lymphocyte ratio (NLR) and CRP/albumin ratio and decreased albumin. The occurrence rates of consolidation, subpleural sparing, crazy-paving pattern, cavity, halo sign, reversed halo sign, air bronchogram, pleural thickening, micronodule, subpleural curvilinear line and multilobar and bilateral involvement in the CT finding of the severe patients were significantly higher than those of the non-severe patients. CONCLUSIONS: Many factors are related to the severity of COVID-19, which can help clinicians judge the severity of the patient and evaluate the prognosis. This cohort study revealed that male sex, age (≥55 years), patients with any comorbidities, especially those with cardiovascular disease, dyspnoea, increased CRP, D-dimer and NLR, and decreased lymphocyte count and CT findings of consolidation and multilobar involvement were predictors of severe COVID-19.

Investigation of the Value of T peak to T end and QTc Intervals as Electrocardiographic Arrhythmia Susceptibility Markers in Acute Ischemic Stroke.

INTRODUCTION: Arrhythmias are one of the most common causes of mortality in patients with acute ischemic stroke (AIS). This study aimed to investigate the relationships of arrhythmia susceptibility markers (QT, QTc, Tpe, Tpe-D, Tpe/QT, and Tpe/QTc) with the localization and volume of the ischemic area, the National Institutes of Health Stroke Scale (NIHSS) scores, and troponin levels in AIS. METHODS: Patients diagnosed with AIS in the emergency department in the period from 01 November 2016 to 31 March 2019 were retrospectively reviewed. Patients admitted to the emergency department with no pathological ECG findings were included. The measurements of QT, QTc, Tpe, Tpe-D, Tpe/QTc, and Tpe/QT were performed under a digital microscope. The NIHSS scores, troponin values, and the ischemic area volume based on the diffusion-weighted magnetic resonance imaging findings at the time of admission were found. RESULTS: A total of 135 patients, comprising 70 AIS patients and 65 individuals as controls, were included in the study. The male/female ratio was 73/62 and the mean age was 68.51±10.80 years. All of the ECG parameters in the AIS group and the control group were statistically significantly different between the groups except Tpe-D (p=0.454) (For QT, QTc, Tpe, Tpe/QTc, and Tpe/QT; p=0.003, 0.022, <0.001, 0.001, 0.001; respectively). QT, QTc, Tpe, Tpe/QTc, and Tpe/QT values were not significantly different between the groups with a NIHSS score of ≤5 and >5 (p=0.480, 0.688, 0.663, 0.512, 0.333, respectively). CONCLUSIONS: Arrhythmia susceptibility markers including QT, QTc, Tpe, the values of Tpe-D, Tpe/QT, and Tpe/QTc are different in AIS patients compared to the individuals in the control group; therefore, these parameters can be included among the other parameters of close cardiac monitoring.

Is visceral obesity associated with colorectal cancer? The first volumetric study using all CT slices.

PURPOSE: We aimed to examine the possible relationship between abdominal adiposity parameters and the presence of colorectal cancer (CRC) and between these adiposity parameters and various histopathologic findings of the tumor. METHODS: A total of 60 control subjects and 111 CRC patients, 63 with early-stage and 48 with advanced-stage disease, were enrolled. Medical data and abdominopelvic computed tomography (CT) examinations of each study group were retrospectively reviewed. Abdominal adiposity parameters, including visceral adipose tissue (VAT) volume, subcutaneous adipose tissue (SAT) volume, and total adipose tissue (TAT) volume, were calculated on all slices of the CT examinations with specialized software, and results for each study group were compared. Adiposity parameters were also compared with tumor histopathologic findings. RESULTS: We found lower VAT and higher SAT volumes in advanced-stage CRC patients, compared with the early-stage group. However, this relationship was not statistically significant (P = 0.721 for VAT and P = 0.432 for SAT volumes). We detected significantly lower VAT and SAT volumes in the early-stage CRC group compared with the control group (P = 0.014 for both). There was no significant relationship between TAT volumes and the study groups (P = 0.06). No statistically significant relationship was detected between adipose tissue parameters and histopathologic features of the CRC group (P > 0.05). CONCLUSION: We found statistically significant lower VAT and SAT volumes in patients with early-stage CRC compared with the control group. Volumetric adipose tissue measurements may be more accurate than area measurements and can easily be performed on abdominopelvic CT examination, which is the routine imaging modality for CRC patients.

Determining the Thyroid Gland Volume Causing Tracheal Compression: A Semiautomated 3D CT Volumetry Study.

Background and objectives: Increased thyroid gland volume (TV) may bring about tracheal compression, which is one of the causes of respiratory distress. The aim of this study was to investigate the relationship between TV and the severity of tracheal compression independent of patients' symptoms using semiautomated three-dimensional (3D) volumetry (S3DV) reconstructed from computed tomography (CT) scans. Cut-off TVs leading to different levels of tracheal narrowing were evaluated. Materials and Methods: One hundred sixty-three contrast-enhanced head and neck CT examinations were retrospectively assessed. TVs were measured by S3DV. The degree of tracheal compression was measured at the point where the greatest percent reduction in the cross-sectional area of the trachea adjacent to the thyroid gland was observed. To determine the severity of compression, the tracheal compression ratio (TCR) was defined (TCR = A1 (the narrowest cross-sectional area of trachea)/A2 (the largest cross-sectional area of trachea)). Results: The mean tracheal narrowing was 15% (TCR = 0.85 ± 0.15) in the study population. Patients with more than 15% tracheal compression had significantly higher TV values than those with less than 15% tracheal compression (p < 0.001). In addition, a significant correlation was found between TV and tracheal compression (p < 0.001). Moreover, the receiver operating characteristic (ROC) curve analysis revealed that the cut-off levels for TV that predict a tracheal narrowing of 10%, 20%, 30%, and 40% were 19.75 mL, 21.56 mL, 24.54 mL, and 30.29 mL, respectively (p < 0.05). Conclusions: This study objectively demonstrated that larger thyroid glands cause more severe compression on the trachea. The results may be helpful during the decision-making process for thyroidectomies to be performed due to compression symptoms.

The value of qualitative and quantitative assessment of lesion to cerebral cortex signal ratio on double inversion recovery sequence in the differentiation of demyelinating plaques from non-specific T2 hyperintensities.

OBJECTIVES: To assess the usefulness of the visual assessment and to determine diagnostic value of the lesion-to-cerebral cortex signal ratio (LCSR) measurement in the differentiation of demyelinating plaques and non-specific T2 hyperintensities on double inversion recovery (DIR) sequence. MATERIAL AND METHODS: DIR and fluid-attenuated inversion recovery (FLAIR) sequences of 25 clinically diagnosed multiple sclerosis (MS) patients and 25 non-MS patients with non-specific T2-hyperintense lesions were evaluated visually and LCSRs were measured by two observers independently. RESULTS: On DIR sequence, the calculated mean LCSR ± SD for demyelinating plaques and non-specific T2-hyperintense lesions were 1.60 ± 0.26 and 0.75 ± 0.19 for observer1, and 1.61 ± 0.27 and 0.74 ± 0.19 for observer2. LCSRs of demyelinating plaques were significantly higher than other non-specific T2-hyperintense lesions on DIR sequence. By using the visual assessment demyelinating plaques were differentiated from non-specific T2-hyperintensities with 92.8 % sensitivity, 97.5 % specificity and 95.1 % accuracy for observer1 and 92.8 % sensitivity, 95 % specificity and 93.9 % accuracy for observer2. CONCLUSION: Visual assessment and LCSR measurement on DIR sequence seems to be useful for differentiating demyelinating MS plaques from supratentorial non-specific T2 hyperintensities. This feature can be used for diagnosis of MS particularly in patients with only supratentorial T2-hyperintense lesions who are categorized as radiologically possible MS. KEY POINTS: • Demyelinating plaques and non-specific T2-hyperintensities have different SI on DIR images. • These differences can be assessed by LCSR measurement or visual assessment. • There is an excellent inter-observer agreement for both methods. • This feature can be used in radiologically possible MS cases.

Imaging Findings of Jugular Foramen Meningocele in a Neurofibromatosis Type 1 Patient.

Neurofibromatosis type I (NF1) is a neurocutaneous disorder that involves autosomal dominant transmission. Skull defects, including sphenoid dysplasia and calvarial defects, are a rare finding in patients with NF1. Spinal meningocele and sphenoid wing dysplasia have been identified in NF1 but the occurrence of meningoceles at the skull base is extremely rare. A rare instance of jugular foramen meningocele being identified in an NF1 patient on imaging is described in this paper. To the best of our knowledge, only two such cases have been reported in the English literature.

Apparent diffusion coefficient value in invasive ductal carcinoma at 3.0 Tesla: is it correlated with prognostic factors?

OBJECTIVE: To investigate the correlation between apparent diffusion coefficient (ADC) values and prognostic factors in patients with invasive ductal carcinoma (IDC). METHODS: 48 lesions belonging to 47 patients with histopathologically proven IDC were examined using conventional MR and diffusion-weighted imaging at a 3.0-T system. All of the patients had modified radical mastectomies or breast-sparing surgery plus axillary lymph node dissection. The ADC values acquired from the ADC maps consisted of six different b-values (0, 50, 100, 500, 1000 and 1500 s mm(-2)) and were compared with the patients' ages, tumour size, histological grade of the lesions, tumour localization, lesions' distance to skin surface and nipples, the existence of axillary lymph node involvement, the number of involved axillary lymph nodes, oestrogen/progesterone receptor status, peritumoral lymphovascular invasion status and the existence of human epidermal growth factor 2 (c-erbB-2) overexpression. RESULTS: A statistically significant relationship was found regarding axillary lymph node involvement (p = 0.027), and oestrogen/progesterone receptor status (p = 0.013). No significant relationship was detected regarding other prognostic factors (p > 0.05). CONCLUSION: Among various prognostic factors, ADC values were significantly correlated with only axillary lymph node positivity and oestrogen/progesterone receptor status. ADVANCES IN KNOWLEDGE: In the present study, the relationship between ADC values of IDC lesions that are acquired at a high magnetic field (3.0 T) system by using multiple b-values and some specific prognostic factors that were not evaluated before in the medical literature was investigated.

Brain herniations into the dural venous sinus or calvarium: MRI findings, possible causes and clinical significance.

OBJECTIVES: To determine frequency, imaging features and clinical significance of herniations of brain parenchyma into dural venous sinuses (DVS) and/or calvarium found on MRI. METHODS: A total of 6160 brain MRI examinations containing at least one high-resolution T1- or T2-weighted sequence were retrospectively evaluated to determine the presence of incidental brain herniations into the DVS or calvarium. MRI sequences available for review were evaluated according to their capability to demonstrate these herniations. Patients' symptoms and clinical findings were recorded. RESULTS: Twenty-one (0.32 %) brain parenchyma herniations into the DVS (n = 18) or calvarium (n = 3) in 20 patients were detected. The most common locations of the herniations were the transverse sinuses (n = 13) and those involving inferior gyrus of the temporal lobe (n = 9). High-resolution T1- and T2-weighted sequences were equally useful in the detection of these brain herniations. According to clinical symptoms, brain herniations were considered to be incidental but headaches were present in nine patients. CONCLUSION: Brain herniations with surrounding cerebrospinal fluid (CSF) into the DVS and/or calvarium are incidental findings and not proven to be associated with any symptoms. Although rare, these herniations are more common than previously recognized and should not be confused with arachnoid granulations, clots or tumours. KEY POINTS: • Brain herniations into the DVS are more common than previously assumed. • The most frequent locations are the transverse sinus. • These herniations are incidental findings. • The relationship between brain herniation into DVS and headache is uncertain. • High-resolution MR sequences are most useful in detection of brain herniations.

Malformations of cortical development: 3T magnetic resonance imaging features.

Malformation of cortical development (MCD) is a term representing an inhomogeneous group of central nervous system abnormalities, referring particularly to embriyological aspect as a consequence of any of the three developmental stages, i.e., cell proliferation, cell migration and cortical organization. These include cotical dysgenesis, microcephaly, polymicrogyria, schizencephaly, lissencephaly, hemimegalencephaly, heterotopia and focal cortical dysplasia. Since magnetic resonance imaging is the modality of choice that best identifies the structural anomalies of the brain cortex, we aimed to provide a mini review of MCD by using 3T magnetic resonance scanner images.

Split-bolus MR urography: synchronous visualization of obstructing vessels and collecting system in children.

Several vascular abnormalities related with urinary system such as crossing accessory renal vessels, retroiliac ureters, retrocaval ureters, posterior nutcracker syndrome, and ovarian vein syndrome may be responsible for urinary collecting system obstruction. Split-bolus magnetic resonance urography (MRU) using contrast material as two separate bolus injections provides superior demonstration of the collecting system and obstructing vascular anomalies simultaneously and enables accurate preoperative radiologic diagnosis. In this pictorial review we aimed to outline the split-bolus MRU technique in children, list the coexisting congenital collecting system and vascular abnormalities, and exhibit the split-bolus MRU appearances of concurrent urinary collecting system and vascular abnormalities.

MRI diagnosis of dural sinus - Cortical venous thrombosis: Immediate post-contrast 3D GRE T1-weighted imaging versus unenhanced MR venography and conventional MR sequences.

OBJECTIVE: Primary aim is to compare the diagnostic value of contrast-enhanced 3D GRE T1-weighted sequences with unenhanced MR venography and conventional magnetic resonance imaging (MRI), in detection of dural venous sinus (DVS) and cortical venous thrombosis; secondary aim is to determine the relationship between DVS thrombosis/site and gender, age, infarction or hemorrhage. METHODS: We retrospectively reviewed conventional MR images, unenhanced MR venography and immediate post-contrast 3D GRE T1-weighted MR images in 30 patients (17 male and 13 female, 21-70 years old, mean age 40.1) with clinically suspected DVS thrombosis. MR examinations had been performed with 1.5T or 3T MR Scanners. DVSs were evaluated in 10 sub-segments, including cortical veins. Each set of MR images were examined separately, blinded to the final diagnosis. Associated findings were also noted and sensitivity, specificity and accuracy of each MRI technique were calculated. RESULTS: Final diagnosis of cortical venous and/or dural sinus thrombosis was established in 24 (80%) of 30 cases and 67 (22.3%) out of 300 segments. For detection of the thrombotic segment, sensitivity, specificity, and accuracy were 83.6%, 95.3%, and 92.7% by conventional MR sequences, 89.6%, 91.8%, and 91.3% by unenhanced MR venography, and 92.5%, 100%, and 98.3% by contrast-enhanced 3D GRE T1-weighted sequence, respectively. Infarction and hemorrhage were more frequent in cases with cortical venous thrombosis, while gender and age had no significant relation with DVS thrombosis or its site. Conventional MR sequences and unenhanced MR venography were helpful due to additional information they provided in some cases with isolated cortical venous thrombosis, with hyperintense thrombus material and with associated hemorrhage or infarction. CONCLUSION: Contrast-enhanced 3D GRE T1-weighted MRI is the most accurate imaging method for the detection of DVS and/or cortical venous thrombosis. Infarction and hemorrhage were more frequent in cases with cortical venous thrombosis.

Prevalence of dual left anterior descending artery variations in CT angiography.

PURPOSE: We aimed to evaluate the frequency and features of dual left anterior descending artery (LAD) variants using computed tomography (CT) angiography. METHODS: A total of 1337 consecutive coronary CT angiography examinations performed between April 2010 and December 2013 were retrospectively evaluated for the presence of dual LAD. CT examinations were performed with either 64- or 320-row multidetector CT scanners. All CT angiography images were evaluated for the presence and morphologic features of dual LAD subtypes. RESULTS: Fifty-six dual LAD variations (4%) were identified in this study population. Type 1 was the most common type of dual LAD (n=48), while Type 3 (n=3) and Type 4 (n=2) were infrequent and Type 2 was not detected. Additionally, we detected previously unclassified dual LAD variations in three cases. CONCLUSION: Dual LAD may be a relatively more common variant than described in the medical literature, which is mostly based on catheter angiography studies. Coronary CT angiography seems markedly efficacious for detecting and documenting the anatomical details of dual LAD subtypes, as well as showing other associated cardiocoronary anomalies.

The anatomic evaluation of the internal mammary artery using multidetector CT angiography.

PURPOSE: To determine the normal anatomic features and variations of the internal mammary arteries (IMAs) and to describe the relationship between the diameter and distance to the sternal edge of the IMAs, gender, and location (right-left) of the IMAs in patients who underwent multidetector computed tomography (MDCT) angiography of the thorax for various reasons. MATERIALS AND METHODS: A total of 164 patients who underwent MDCT angiography of the thoracic vascular structures for various reasons were analyzed retrospectively. The right and left IMAs were analyzed individually, and normal anatomic features and variations were recorded. The relationships between gender, side and diameter of the IMAs, and distance to the sternal edge of the IMAs were evaluated. RESULTS: There were 328 (164 right, 164 left) IMAs in 164 patients (110 males, 54 females; mean age, 43.96 years). A total number of five arteries (1.5%) had anatomic variation. Whereas 325 IMAs had an origin separate from the subclavian artery, three LIMA of the 328 arteries (0.91%) had a common origin with the thyrocervical trunk or costocervical trunk. Two (0.6%) IMAs (one LIMA and one RIMA) in the same patient were duplicated at the level of the first and second costal cartilage. There were no statistically significant correlations between age and diameter or between gender and diameter of the RIMA and LIMA at the origin and level of tracheal bifurcation (P > 0.05). Mean distance between the lateral margin of the sternum and midpoint of LIMA and RIMA were 12.42 mm and 13.00 mm, respectively. CONCLUSION: The normal anatomic features and variations of the IMAs have an important role in cardiovascular bypass surgery, breast reconstruction, and percutaneous transthoracic procedures. MDCT angiography allows a precise and detailed evaluation of IMAs.

Normal anatomical features and variations of bronchial arteries: an analysis with 64-detector-row computed tomographic angiography.

OBJECTIVE: To determine the normal anatomical features and variations of the bronchial arterial system and to determine the relationship among ectopic bronchial arteries, location (right-left) of the bronchial arteries, and variations of the aortic arch in patients as well as the sex of the patients who underwent multidetector computed tomographic angiography of the thorax for various reasons. METHODS: A total of 163 patients who underwent multidetector computed tomographic angiography of the thoracic vascular structures for various reasons were analyzed retrospectively. The right and left bronchial arteries were analyzed individually, and normal anatomic features and variations were recorded. The χ and Mann-Whitney U tests were used to evaluate relationships among the patients' sex, side and number of the bronchial arteries, aortic arch variations, and bronchial artery variations. RESULTS: There were 432 bronchial arteries (right, 229; left, 203) in 163 patients (117 men, 46 women; mean age, 51.7 years). All of the patients have at least one bronchial artery (mean, 2.65; maximum, 5). The number and diameters of the bronchial arteries were statistically higher on the right side. The number of the bronchial arteries was significantly higher in the men (P < 0.05). Ectopic bronchial arteries were present in 43 (26.4%) of the 163 patients. Aortic arch variations were present in 27 (22.5%) of 120 patients with normal bronchial arteries and in 11 (25.6%) of the 43 patients with ectopic bronchial arteries. There was no statistically significant correlation between aortic arch variations and ectopic bronchial arteries (P = 0.861). CONCLUSIONS: The anatomic features of the bronchial arteries show differences between individuals and the sexes. Multidetector computed tomographic angiography allows a precise and detailed evaluation of bronchial arterial system.