Correlation between kinking and coiling of the carotid arteries as assessed using MDCTA with symptoms and degree of stenosis.

AIM: To evaluate whether the presence of kinking and coiling of the carotid arteries is associated with symptoms and an increased degree of carotid artery stenosis. MATERIALS AND METHODS: One hundred and fifty-three consecutive patients examined using multidetector-row computed tomography angiography (MDCTA) were studied retrospectively. The arterial phase was obtained by injecting 4-6ml/s of contrast material. A total of 306 carotid arteries were assessed for the presence of tortuosity. The degree of carotid artery stenosis was measured according to North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Logistic regression analysis was performed to determine whether an independent association existed between the presence of vessel tortuosity, symptoms, and the degree of carotid artery stenosis. RESULTS: Kinking was detected on 37 occasions (12.1%) and coiling on 20 occasions (6.5%). Using Yates's corrected chi-square test, an association between kinking and symptoms (p=0.002) was observed, but not between coiling and symptoms (p=0.31). Logistic regression confirmed that the strongest association was present between stenosis degree and symptoms (p=0.001), but kinking (p=0.009) and age (p=0.001) were also significantly associated with symptoms. A Mann-Whitney test did not demonstrate correlation between coiling (p=0.16) or kinking (p=0.22) and increased degree of carotid artery stenosis. CONCLUSION: The results suggest that kinking may be associated with symptoms, whereas coiling does not appear to be associated with symptoms. The degree of carotid artery stenosis severity is not related to the presence of vessel tortuosity.

Study of endoleaks after endovascular repair by using MDCTA.

PURPOSE: Our purpose was to investigate the multi-detector-row CT angiography (MDCTA) application in endoleak detection. METHODS: Fifty-nine patients that underwent endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm with endoluminal stent graft were retrospectively studied. MDCTA scans were obtained after administration of 110-130 mL of contrast material using a 4-6 mL/sec flow rate. We made unenhanced, arterial (15-20 sec) and delayed (100 sec) acquisitions. For each patient four MDCTA datasets (pre-EVAR, 1, 6, and 12 months follow-up) were obtained. Each examination was studied by two observers. Kappa value was calculated in order to evaluate inter-observer agreement. RESULTS: Twenty-one endoleaks were detected in eighteen patients. Fifteen and eighteen endoleaks were detected by using biphasic arterial CT and biphasic delayed CT respectively (sensitivity of 71.4% and 85.7% respectively). We observed a positive correlation between the presence of endoleak and the increasement in aneurysm size. Interobserver agreement was 88.1% and kappa value was 0.685. CONCLUSIONS: Biphasic CT for endoleak detection is significantly superior to arterial and delayed phases respectively. We observed a good interobserver agreement.

Superior mesenteric artery spontaneous and isolated dissection diagnosed by using MDCTA.

We report the case of a 49-year-old man admitted to our Institute because he suffered acute abdominal pain induced by eating. Sonography don't revealed pathological findings. Then underwent a multi-detector row computed tomography angiography (MDCTA) that revealed an intimal flap separating true and false lumens that was located 2 cm from the origin of the superior mesenteric artery (SMA) and with an extension of 8 cm. Since the dissection was limited without occlusion of the SMA and the mesenteric marginal artery served as a collateral vessel on the distal side of the SMA, the treatment has been conservative. Improved CT technology facilitates the diagnosis of superior mesenteric artery dissection. Prompt diagnosis and treatment result in the lowest mortality rate and minimize the prevalence of intestinal infarction. Only 107 cases (including the present case) of isolated spontaneous SMA dissection without associated aortic dissection were identified from the literature.

Role and application of hysterosalpingography and Fallopian tube recanalization.

AIM: The prevalence of infertility in the United States is 15-20% and this condition represents an important medical problem. The purpose of this work was to evaluate therapeutical efficacy of 2 consecutive hysterosalpingography (HSG) followed each other after 4 week compared with the fallopian tube recanalization (FTR). METHODS: Two groups of 80 patients paired for mean age and age range (age range, 23-37 years; mean age, 30 years), were assessed for pregnancy rate (two-year follow-up) by using two consecutive HSG in one group and HSG and tube recanalization in the second group. Pain perception and dose delivered were assessed. Statistical analysis was performed to evaluate significant differences between the two approaches. RESULTS: Pregnancy rate after TFR was 51% whereas pregnancy rate after two consecutive HSG was 31.3% (P= 0.016; OR 2.31) and all the pregnancies were observed in those women that showed a positive variation in second HSG with a pregnancy rate of 47% (P=0.776; OR=1.18). In one case a serious complication was observed (1.25%): a tubal perforation. Minor bleeding sometimes lasted for as long as 48 h but never required any medical treatment. Pain assessment and dose delivered were statistically different by using these two methods (P= 0.027 and P<0.001, respectively) CONCLUSION: Therapeutical efficacy of two consecutive HSG followed each other after four week compared with the FTR are similar when the second HSG shows the presence of Fallopian tube patency.

Fissured fibrous cap of vulnerable carotid plaques and symptomaticity: are they correlated? Preliminary results by using multi-detector-row CT angiography.

PURPOSE: Carotid artery plaque with a disrupted fibrous cap is characterized by a higher tendency to rupture, resulting in a higher rate of transitory ischemic attack and stroke. The purpose of our study was to evaluate whether there is a statistically significant correlation between the presence of fissured fibrous cap (FFC) (assessed by using multi-detector-row CT angiography (MDCTA)) and ipsilateral symptomaticity. MATERIAL AND METHODS: 147 patients (105 males, 42 females; mean age 63 years, range 37-84) with a stenosis of at least 50% or a plaque alteration at sonography were retrospectively studied, yielding a total of 294 carotid arteries, by using a multi-detector-row CT (MDCT) scanner. A search for detection of FFC and a correlation with previously registered data about patients' symptomaticity by using statistical assessment were performed. Each examination was assessed independently by two readers and interobserver agreement was calculated. RESULTS: Among the 147 patients included in the study group, 15 were excluded because of inadequate quality images. In the 132 remaining patients, for a total of 264 carotids assessed, 30 FFCs were detected by using MDCTA and overall there were 36 symptomatic patients (12 ipsilateral symptomatic patients with FFC). A statistical correlation between the presence of FFC and symptomaticity (p = 0.0032) was found. The kappa value between readers was 0.781. CONCLUSIONS: MDCT may depict FFC and the results of our study suggest that FFC may be used as an indicator for prediction of potential cerebrovascular pathology. The interobserver agreement obtained was good.

Multidetector row CT of the brain and carotid artery: a correlative analysis.

AIM: To evaluate the association between types of carotid plaque, the presence of prior ischaemic events detectable with CT, and patient's symptoms. MATERIALS AND METHODS: Between January 2004 and May 2006, 112 patients were evaluated using multidetector row computed tomography angiography (MDCTA) of the carotid arteries and computed tomography (CT) of the brain. Carotid arteries were categorized by evaluating the degree of stenosis according to North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, the type of plaque, and the presence of plaque ulceration. The brain was assessed via CT for the presence, type, and position of lesions. Chi-square tests, Student's t test, and simple logistic regression analysis were performed and the Cohen kappa test was applied for interobserver variability measurement. RESULTS: The Chi-square test indicated a statistically significant association between the presence of fatty plaques (p=0.005) and CT-detectable lesions in the brain (p=0.004). Moreover, the number of patients with CT-detectable brain lesions was greater in patients with >70% stenosis than in those with <70% stenosis (p=0.007). Logistic regression confirmed the association between fatty plaque and symptoms (p=0.001), between >70% stenosis and symptoms (p=0.041), and an inverse association between calcified plaque and symptoms (p=0.009). CONCLUSION: MDCTA allows adequate evaluation of the type of plaque. The results of the present study indicate that there is an association between cerebral lesions, symptoms, and fatty plaque in the carotid artery. The degree of stenosis also correlated with cerebral lesions and symptoms. According to the obtained data, the type of carotid plaque should be included among primary parameters in the classification of patients' risk class.

Imaging of the endoleak after endovascular aneurysm repair procedure by using multidetector computer tomography angiography.

Abdominal aortic aneurysms (AAA) are an important cause of death in elderly men. Most used treatment options are endovascular aneurysm repair (EVAR) and open surgical repair. After the endovascular stent graft placement, however, several complications may occur and an important complication of EVAR is endoleak formation which occurs in approximately one-fourth of patients. Endoleak represents a blood flow outside the stent graft lumen but within the aneurysm sac. For these reasons, unlike the minimal imaging follow-up that is typically performed after surgical repair, patients undergoing EVAR require a life-long postoperative surveillance imaging. In the last years, with the advent of multidetector-row CT (MDCT) scanners and the use of specific angiographic protocols (multidetector CT angiography, MDCTA), CT imaging became the most commonly used examination for endoleak detection. Moreover, the volume data obtained can be further rendered to generate high quality two-dimensional (2D) and three-dimensional (3D) images, that allow a better distinction between Endoleak type II, III and IV. Purpose of this study was to review and describe MDCTA potentialities in the detection of endoleak after EVAR procedures.

Accessory renal artery stenosis and hypertension: are these correlated? Evaluation using multidetector-row computed tomographic angiography.

BACKGROUND: Renal artery stenosis may produce hypertension, and this condition is referred to as renovascular hypertension (RVH). PURPOSE: To evaluate, by using multidetector-row spiral computed tomographic angiography (MDCTA), whether a relationship between accessory renal artery stenosis and hypertension may be hypothesized. MATERIAL AND METHODS: 214 patients (142 males, 72 females; mean age 66 years) who had previously undergone an MDCTA to study the abdominal vasculature were retrospectively studied. Patients with renal artery stenosis (RAS) were excluded from this analysis. The patients were studied by means of a four-detector-row CT, and scans were obtained after intravenous bolus administration of 110-140 ml of a nonionic contrast material with a 3-6 ml/s flow rate. As a second step, by means of statistical analysis, hypertension data were compared with findings of accessory artery stenosis. Two radiologists first independently reviewed the MDCTA images and then, in case of disagreement, in consensus. Interobserver agreement was calculated for all measurements. RESULTS: The overall number of detected accessory renal arteries was 74 in 56 of the 214 patients. Accessory renal artery stenosis was detected in 21 of the 56 patients. There was a difference in the prevalence of hypertension between patients with (n = 21) and without (n = 35) accessory renal artery stenosis (P = 0.0187). Interobserver agreement was good (kappa value 0.733). CONCLUSION: Any statistical association between the presence of accessory renal artery stenosis and hypertension could not be disclosed. However, accessory renal artery stenosis, detected by MDCTA, is an important pathological sign that the radiologist has to assess in the light of its possible association with hypertension.

Diagnostic sensitivity of multidetector-row spiral computed tomography angiography in the evaluation of type-II endoleaks and their source: comparison between axial scans and reformatting techniques.

BACKGROUND: After endovascular stent-graft placement, several complications may occur. Retrograde filling of the aneurysm (type-II endoleak) is the most common. PURPOSE: To evaluate the accuracy, image quality, and interobserver agreement of multidetector-row spiral computed tomography angiography (MDCTA) in the diagnosis of type-II endoleak, by using various types of reformatting techniques in comparison to regular axial images. MATERIAL AND METHODS: Twenty-four patients who had had endovascular repair of an infrarenal abdominal aortic aneurysm with stent graft were retrospectively studied. In 12 of 24 patients, a type-II endoleak was found. CT scans were obtained after intravenous administration of 130 ml of nonionic contrast material using a 4-6-ml/s flow rate. All patients were investigated with axial scans, multiplanar reconstruction (MPR), maximum intensity projection (MIP), shaded-surface display (SSD), and volume-rendering (VR) techniques. For each patient and for each reconstruction method, the image quality of the scans was scored as 0 for bad quality, 1 for poor quality, 2 for good quality, and 3 for excellent quality images. Two radiologists reviewed the CT images independently. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each reconstruction method, with the axial images as the reference method. Interobserver agreement and kappa value were also recorded. RESULTS: MPR showed the highest sensitivity (83% and 67% for observers 1 and 2, respectively), PPV (91% and 80% for observers 1 and 2, respectively), and NPV (85% and 71% for observers 1 and 2, respectively), whereas VR showed the highest specificity (92% for both observer 1 and 2). CONCLUSION: Reformatting techniques provide good-quality images; nevertheless, their efficacy in the study of type-II endoleak was found to be suboptimal in comparison to regular axial images. The MPR technique is probably the best choice in conjunction with axial images.

Differences between MIP and MPR techniques in the carotid artery stenosis degree measurement. Evaluation using multi-detector-row CT angiograph.

AIM: Stroke is the third leading cause of mortality in the world and the stenosis degree is considered a fundamental parameter for the definition of the therapeutic approach. With the development of Multi-Detector-Row CT (MDCTA) scanner, computed tomography has become a widely used imaging technique for categorizing carotid artery stenosis degree. The purpose of this paper is to compare two CT post-processing procedures, maximum intensity projection (MIP) and multi planar reconstruction (MPR) in order to evaluate their sensitivity and inter-technique agreement. METHODS: For the purpose 45 patients (35 males and 10 females), that underwent MDCTA for carotid artery evaluation, have been retrospectively evaluated. Data set were processed with the study group's workstations, by using MPR and MIP algorithms. Each patient was assessed for stenosis degree by using North American Symptomatic Carotid Endarterectomy Trial method. Statistic analysis was performed to determine the sensitivity of the used procedure. The Cohen kappa test was applied to assess the level of intra-observer agreement. Image quality was also evaluated. RESULTS: MPR sensitivity was 87.8% (95% confidence interval [CI] 81-94.5%) and MIP sensitivity was 91.1% (95% CI 85.2-97%). Agreement in MPR was 0.792 with a standard error (SE) of 0.066, and agreement in MIP was 0.836, with a SE of 0.072. CONCLUSION: Results of the study indicate the MIP algorithm is more sensitive than MPR. Best intra-observer agreement and image quality results were also observed in the MIP. Data suggest also that MIP should be the post-processing procedure to be utilized in the evaluation of carotid artery stenosis degree, when using MDCTA. Presence of big calcified plaque can determine difficulties in MIP evaluation of stenosis degree.

Osteoma of the mandible: case report and application of multi-detector-row CT rendering technique.

Osteoma is an uncommon benign slow growing neoplasm of the bone, characterized by proliferation of osteoblasts forming bone trabeculas in a connective tissue stroma. After paranasal sinus, mandible is its second most frequent location. The osteoma can be central, peripheral or of extraskeletal type. Peripheral osteomas are quite uncommon. This fact suggests that peripheral osteoma of the mandible may be traumatically damaged, mostly because of muscle traction. This paper reports a case of peripheral osteoma located in the mandible. The patient underwent a multi-detector-row computed tomography (MDCT) in order to plan corrective surgery. MDCT images were post-processed with volume rendering techniques.

CT and ultrasound in the study of ulcerated carotid plaque compared with surgical results: potentialities and advantages of multidetector row CT angiography.

BACKGROUND AND PURPOSE: Ulceration is a severe complication of carotid plaque. The purpose of this study was to evaluate the role and the diagnostic efficacy of multidetector row CT angiography (MDCTA) and ultrasound (US) echo color Doppler (US-ECD) in the study of patients with carotid plaque complicated by ulceration through the comparison with the surgical observation. MATERIALS AND METHODS: From January 2004 to October 2005, 237 patients, for a total of 474 carotid arteries, studied at first with color Doppler US, were analyzed using CT angiography. A total of 103 patients underwent a carotid endarterectomy. We analyzed stenosis degree, plaque composition, and presence of ulcerations. In a second phase, the data were compared with the surgical results when the MDCTA indicated surgical intervention. RESULTS: MDCTA found 31 ulcerations; the surgical confirmation underlined a 93.75% sensitivity and a 98.59% specificity. US-ECD performances were 37.5% and 91.5% for sensitivity and specificity, respectively. The number of patients who showed plaque ulcerations increased with the severity of stenosis. Furthermore, ulcerations of the carotid plaque occurred more often proximal than distal to the point of maximum stenosis, and this trend increased with the severity of the stenosis. We also determined that fatty plaques were more likely to be affected by ulcerations. CONCLUSIONS: The results of our study suggest that MDCTA detects with higher sensitivity and specificity the presence of ulcerated plaque compared with US-ECD, which has been demonstrated to be less effective in this evaluation. Considering the high MDCTA sensitivity and specificity for detection of plaque ulceration, we therefore recommend MDCTA as a useful step for correct presurgical planning.

Efficacy and sensitivity of axial scans and different reconstruction methods in the study of the ulcerated carotid plaque using multidetector-row CT angiography: comparison with surgical results.

BACKGROUND AND PURPOSE: Carotid plaque ulceration is an important risk factor for stroke, and its diagnosis may be very important to plan a correct therapeutic approach. We hypothesized that axial scans and various reconstruction methods could have different specificity and sensitivity in the study of plaque ulceration. The object of this study was to evaluate their role and diagnostic efficacy in patients with carotid plaque complicated by ulceration through the comparison with surgical results. MATERIALS AND METHODS: From January 2004 to November 2005, 109 patients who underwent a carotid endarterectomy were analyzed using CT angiography for a total of 218 carotid arteries. We assessed every carotid for the presence of ulcerations. For each patient axial image, maximum intensity projection (MIP), multiplanar reconstruction (MPR), shaded surface display (SSD), and volume rendering (VR) reconstructions were obtained. RESULTS: Multidetector row CT angiography (MDCT) found 32 ulcerations; surgical confirmation underlined an overall 93.9% sensitivity (95% confidence interval [CI] 0.858-1.021), and a 98.7% specificity (95% CI, 0.961-1.012). Axial scans and volume rendering images demonstrated the highest sensitivity (90.9% and 87.9%, respectively); SSD, on the contrary, showed the lowest sensitivity: 39.4% (95% CI sensitivity, 0.227-0.561). CONCLUSION: Axial scans plus VR reconstruction techniques offer superior depiction of carotid plaque ulceration compared with MIP, MPR, and SSD.

Spiral computed tomography imaging of bowel ischemia: a literature review.

The aim of this study was to evaluate the reported diagnostic efficacy of multidetector-row computed tomography (MDCT) for bowel ischemia and to identify the radiological signs that permit diagnosis. Based on a review of the literature, spiral CT sensitivity and specificity data were compared, as was the impact of last-generation CT scanner technology on the diagnosis of bowel ischemia. The data source was the PubMed database, from which 106 articles published in English from January 1998 to January 2006 were selected: 18 studies met the inclusion criteria. MDCT was reported to be more sensitive than CT for diagnosing bowel ischemia. The most frequent signs of disease were bowel wall thickening, intramural pneumatosis, mesenteric or portal venous gas, and mesenteric arterial or venous thromboembolism. The results of the literature review suggest that MDCT has high sensitivity for detecting bowel ischemia. Moreover, the use of MDCT angiography to evaluate abdominal vessels offers a better definition of vascular mapping and of the complications of bowel disease.

[Portosystemic shunt encephalopathy. Clinical and radiological evaluation by using multidetector-row CT angiography]. / Encefalopatia da shunt portosistemico. Valutazione clinica e radiologica con angio-TC multidetettore.

We describe the case of a 72-year-old woman who presented a symptomatology characterized by recurrent episodes of confusion, weakness with cerebral vasculopathy. The high values of ammonium were correctly defined thanks to the diagnostic multidetector-row CT information and we referred the symptoms to porto-systemic shunts with the exclusion of hepatic vascularization due to an inferior vena cava stenosis.

[Diagnostic and therapeutic problems in angiodysplasias of the digestive tract]. / Problemi diagnostici e terapeutici nelle angiodisplasie dell'apparato digerente.

After a review of recent literature on angiodysplasias of the digestive system, a diagnostic procedure based on personal experience is proposed for haemorrhagic patients. Criteria for the selection of treatment protocols are then proposed for cases where angiodysplasia is recognised as the cause of the bleeding.

[Use of vasopressin in the treatment of acute hemorrhagic lesions of the stomach. Our experience]. / Impiego della vasopressina nel trattamento delle lesioni emorragiche acute dello stomaco. Nostra esperienza.

Since bleeding from acute lesions of the gastric mucosa can cease spontaneously and the mortality rate of emergency surgery is high, conservative treatment is always preferable. Satisfactory results were obtained with continuous infusions of vasopressin in low doses (0.2 U/kg/hr for 8 hours) so that this treatment appears a valid alternative to more recent techniques (somatostatin).

[The role of endorectal echography for determining the extent of an operation]. / Rol' éndorektal'noi ékhografii dlia opredeleniia ob''ema operatsii.

The paper discusses the usefulness of endorectal echotomography and adenolymphoscintigraphy--two new diagnostic methods which allow surgeons to know preoperatively tumor extension beyond the rectal wall and lymph nodes involvement. Though the statistical data presented are not numerous, it is hoped that, using these two diagnostic methods in cases of rectal tumors, surgeons will be able to choose better between local excision and abdominoperineal resection thus avoiding unnecessary and mutilating operations.

Carotid artery wall thickness measured using CT: inter- and intraobserver agreement analysis.

SUMMARY: The purpose of this work was to compare inter- and intraobserver agreement in the analysis of CAWT by using MDCTA. The CAWT in 35 patients was quantified by 4 observers. Bland-Altman statistics were used to measure the agreement between observers. The results of our study demonstrated that the CAWT measured by using MDCTA shows a good reproducibility between observers by considering inter- and intraobserver agreement.

Computed tomography carotid wall plaque characterization using a combination of discrete wavelet transform and texture features: A pilot study.

In 30% of stroke victims, the cause of stroke has been found to be the stenosis caused by plaques in the carotid artery. Early detection of plaque and subsequent classification of the same into symptomatic and asymptomatic can help the clinicians to choose only those patients who are at a higher risk of stroke for risky surgeries and stenosis treatments. Therefore, in this work, we have proposed a non-invasive computer-aided diagnostic technique to classify the detected plaque into the two classes. Computed tomography (CT) images of the carotid artery images were used to extract Local Binary Pattern (LBP) features and wavelet energy features. Significant features were then used to train and test several supervised learning algorithm based classifiers. The Support Vector Machine (SVM) classifier with various kernel configurations was evaluated using LBP and wavelet features. The SVM classifier presented the highest accuracy of 88%, sensitivity of 90.2%, and specificity of 86.5% for radial basis function (RBF) kernel function. The CT images of the carotid artery provide unique 3D images of the artery and plaque that could be used for calculating percentage of stenosis. Our proposed technique enables automatic classification of plaque into asymptomatic and symptomatic with high accuracy, and hence, it can be used for deciding the course of treatment. We have also proposed a single-valued integrated index (Atheromatic Index) using the significant features which can provide a more objective and faster prediction of the class.