To our knowledge, the utility of coronary covered stents in the treatment of atherosclerotic caro... more To our knowledge, the utility of coronary covered stents in the treatment of atherosclerotic carotid artery stenosis has not been defined in the English-language literature. Covered stents may prevent microembolic complications in select atherosclerotic carotid lesions, as they exclude the atherosclerotic lesion from the circulation by pressing the plaque against the vessel wall. Our early clinical experience has shown that use of these stents can be a therapeutic option in select cases of atherosclerotic stenosis of the cervical internal carotid artery.
Vertebral vacuum sign is an uncommon finding, which can easily mimic the air within the disc and ... more Vertebral vacuum sign is an uncommon finding, which can easily mimic the air within the disc and can be overlooked. We present a case of intravertebral vacuum phenomenon with exquisite multidetector computed tomography and magnetic resonance imaging findings.
Purpose: This retrospective study evaluated the unenhanced multi-detector computed tomography (MD... more Purpose: This retrospective study evaluated the unenhanced multi-detector computed tomography (MDCT) findings of urinary system calculi and the secondary signs associated with ureteral stones in children. Materials and methods: The study included 87 children (54 boys, 32 girls) with a mean age of 89 months (range: 5 months to 16 years) who were referred to us from various departments and were evaluated with unenhanced MDCT between January 2004 and June 2005. The patients were retrospectively evaluated by 2 radiology specialists by means of PACS (picture archiving and communication systems) with regard to the presence of stones, and localization and secondary signs associated with ureteral stones, such as hydronephrosis, proximal ureteral dilatation, unilateral renal enlargement, perinephric edema, tissue rim sign, decreased renal density, and periureteral edema. Patients were scanned by 4- and 16-slice MDCT. Results: Urinary system calculi were detected in 47 (54%) children. An isolated stone in the urinary bladder was detected in one patient. In the remaining 46 children, 43 of the detected stones were renal stones and 23 of them were ureteral stones. Secondary signs associated with ureteral stones were detected in 69.6% of children who had ureteral stones. Conclusion: MDCT provided evaluation of the secondary signs associated with ureteral stones as well as the direct visualization of the stones in cases with urinary stone disease. The ability of MDCT to detect the secondary signs associated with ureteral stones supported the diagnoses and may aid in diagnosis when difficulties are present.
Journal of stroke and cerebrovascular diseases, 2014
The use of narrower window width settings on computed tomography (CT) improves sensitivity for de... more The use of narrower window width settings on computed tomography (CT) improves sensitivity for detection of early ischemic changes in acute ischemic stroke. This study analyzed the effect of optimization of window settings on the accuracy of Alberta Stroke Program Early Computed Tomography Score (ASPECTS) performed on noncontrast CT (NCCT) and CT angiography source images (CTA-SI). ASPECTS was calculated on NCCT and CTA-SI with standard and optimized window width/center settings in a consecutive series of patients with acute ishcemic stroke. The difference between CT-based ASPECTS and ASPECTS performed on follow-up magnetic resonance imaging (MRI) were calculated to determine the disparity between initial estimates of the extent of ischemia on CT and follow-up lesion imaging by MRI. Forty-four patients were included into the study. The mean difference with respect to follow-up MRI-ASPECTS was 4.1 6 2.2 for standard NCCT-ASPECTS, 3.7 6 2.3 for optimized NCCT-ASPECTS, 3.0 6 2.2 for standard CTA-SI-ASPECTS, and 2.7 6 2.1 for optimized CTA-SI-ASPECTS. The improvement introduced by the optimization of window settings and use of CTA-SI was statistically significant (P ,.01). Our data indicate that the accuracy of ASPECTS is improved with optimized window display settings. This improvement is irrespective of experience or specialty of the rater performing the assessment.
The aim of this study was to evaluate efficiency of embolotherapy in management of retroperitonea... more The aim of this study was to evaluate efficiency of embolotherapy in management of retroperitoneal bleedings. A total of 16 patients with retroperitoneal bleeding who underwent angiography followed by transcatheter embolization within a 4-year period in a single centre were reviewed retrospectively. Electronic charts as well as procedural reports were reviewed to assess immediate angiographic findings and results of embolization. Computed tomography was carried out in eight patients. All computed tomography scans showed retroperitoneal haematoma. In addition, contrast material extravasation consistent with active bleeding was seen in two patients and pseudoaneurysm in one. In the remaining eight patients, diagnosis of retroperitoneal bleeding was established based on combined ultrasound and clinical findings. The technical success rate for selective embolotherapy was 100%. Five of these 16 patients (three women and 13 men) had lumbar artery injury; 10 patients were associated with renal artery injury and one had bilateral internal iliac artery injury. Angiography showed active extravasation, pseudoaneurysm and arteriovenous fistula. For embolization, coils were used in six patients and N-butyl-2-cyanoacrylate in the remaining 10 patients. Four patients died within 1 month of embolotherapy. Transcatheter embolotherapy appears to be a life-saving, safe and effective treatment for retroperitoneal bleedings that may be carried out in emergency situations in haemodynamically unstable patients.
FIG. 1 (a-e). Fusion axial slice formed by dual-energy CT (a), 190 keV axial slice (b), 40 keV ax... more FIG. 1 (a-e). Fusion axial slice formed by dual-energy CT (a), 190 keV axial slice (b), 40 keV axial slice (c), iodine-extracted axial slice (d), and iodine map (e). On the high keV (b) and iodine-extracted slices (d), the lesion (circle) is not visible, whereas on the fusion axial slice (a), distinguishing it from the surrounding tissue is quite difficult. The lesion can be easily noticed when looking at the low-voltage image (c) and iodine map images (e)
CardioVascular and Interventional Radiology, Sep 29, 2005
An 84-year-old woman with a history of hypertension and coronary artery disease was admitted with... more An 84-year-old woman with a history of hypertension and coronary artery disease was admitted with a progressively worsening diffuse abdominal pain. Computed tomography scan of the abdomen and angiography revealed occlusion of the origin and proximal portion of superior mesenteric artery. Aortography also showed severe origin stenosis of inferior mesenteric artery and that the distal part of the superior mesenteric artery was supplied by a prominent marginal artery of Drummond. Patient was effectively treated with percutaneous transluminal angioplasty and stenting of the inferior mesenteric artery. Follow-up imaging studies demonstrated patency of the stent and spontaneous recanalization of superior mesenteric artery occlusion.
We studied the proportion of normal appendices, identified on non-contrast MDCT scans of the abdo... more We studied the proportion of normal appendices, identified on non-contrast MDCT scans of the abdomen and pelvis in children with possible renal stones. A total of 105 patients were included in the study, comprising 40 girls (38%) and 65 (62%) boys, with a mean age of 7.3 years. Non-enhanced abdominal computed tomographies were evaluated retrospectively, and the visualization, location, contents, diameter of the appendix, and the amount of abdominal fat were recorded. The appendix was clearly distinguished in 72 patients (68.5%). The difference in appendix visualization rates between patients with low and medium amounts of abdominal fat was statistically significant (p < 0.001). Visualization increased with age. The greatest external diameter was between 2.8 and 10 mm, with a mean of 5 +/- 1.34 mm. MDCT without contrast will be more useful when used in patients of 6 years old and over, for visualization of the appendix. A better visualization of retrocaecal appendix by MDCT provides a greater advantage over US. Prospective comparative studies will determine the role of this method in the diagnosis of acute appendicitis in pediatric patients.
Bleeding pulmonary artery pseudoaneurysm secondary to squamous cell lung cancer: computed tomogra... more Bleeding pulmonary artery pseudoaneurysm secondary to squamous cell lung cancer: computed tomography findings and endovascular management. Acta Radiol 2006;47:944-946. A case of bleeding pulmonary artery pseudoaneurysm secondary to squamous cell lung cancer is reported. The patient presented with massive hemoptysis, diagnosis was made with multidetector computed tomography, and the pseudoaneurysm was successfully embolized with platinum coils. Hemoptysis ceased following the procedure.
An unusual variation of the iliac veins was detected by computed tomography (CT) angiography in a... more An unusual variation of the iliac veins was detected by computed tomography (CT) angiography in a 35-year-old man. In coronal CT reconstructions, it was shown that the right internal iliac vein of this patient crossed to the left side and drained to the left common iliac vein. This variation is important in retroperitoneal, laparoscopic and orthopedic surgery. We present the CT findings and discuss the embryological origin of this unusual congenital anomaly. Veine iliaque interne droite tributaire de la veine iliaque commune gauche. Un cas de´couvert par angio-scanner Re´sume´Une variation inhabituelle des veines iliaques a e´te´de´couverte par tomodensitome´trie chez un malade de 35 ans. Les reconstructions coronales ont montre´que la veine iliaque interne droite du patient croisait la ligne me´diane vers la gauche pour se drainer dans la veine iliaque commune gauche. Cette variation est importante a`connaıˆtre en chirurgie re´tro-pe´ritone´ale, laparoscopique et orthope´dique. Nous pre´sentons les documents obtenus par tomodensitome´trie et discutons l'origine embryologique de cette anomalie conge´nitale rare.
Objectives There is increasing evidence that thrombotic events occur in patients with coronavirus... more Objectives There is increasing evidence that thrombotic events occur in patients with coronavirus disease (COVID-19). We evaluated lung and kidney perfusion abnormalities in patients with COVID-19 by dual-energy computed tomography (DECT) and investigated the role of perfusion abnormalities on disease severity as a sign of microvascular obstruction. Methods Thirty-one patients with COVID-19 who underwent pulmonary DECT angiography and were suspected of having pulmonary thromboembolism were included. Pulmonary and kidney images were reviewed. Patient characteristics and laboratory findings were compared between those with and without lung perfusion deficits (PDs). Results DECT images showed PDs in eight patients (25.8%), which were not overlapping with areas of ground-glass opacity or consolidation. Among these patients, two had pulmonary thromboembolism confirmed by CT angiography. Patients with PDs had a longer hospital stay (p = 0.14), higher intensive care unit admission rates (p = 0.02), and more severe disease (p = 0.01). In the PD group, serum ferritin, aspartate aminotransferase, fibrinogen, D-dimer, C-reactive protein, and troponin levels were significantly higher, whereas albumin level was lower (p < 0.05). D-dimer levels ≥ 0.485 μg/L predicted PD with 100% specificity and 87% sensitivity. Renal iodine maps showed heterogeneous enhancement consistent with perfusion abnormalities in 13 patients (50%) with lower sodium levels (p = 0.03). Conclusions We found that a large proportion of patients with mild-to-moderate COVID-19 had PDs in their lungs and kidneys, which may be suggestive of the presence of systemic microangiopathy with micro-thrombosis. These findings help in understanding the physiology of hypoxemia and may have implications in the management of patients with COVID-19, such as early indications of thromboprophylaxis or anticoagulants and optimizing oxygenation strategies. Key Points • Pulmonary perfusion abnormalities in COVID-19 patients, associated with disease severity, can be detected by pulmonary DECT. • A cutoff value of 0.485 μg/L for D-dimer plasma levels predicted lung perfusion deficits with 100% specificity and 87% sensitivity (AUROC, 0.957). • Perfusion abnormalities in the kidney are suggestive of a subclinical systemic microvascular obstruction in these patients.
Purpose To investigate feasibility of high-pitch acquisition protocol for imaging of pediatric ab... more Purpose To investigate feasibility of high-pitch acquisition protocol for imaging of pediatric abdomen. Materials and methods The study group consisted of 90 patients scanned with high-pitch acquisition protocol (pitch = 3) by 64-slice dual-source CT (DSCT) scanner. Fifty-four patients scanned with standard protocol (pitch = 1.5) by 16-slice singlesource CT scanner comprised the control group. Anteroposterior and lateral diameters of abdomen, effective diameter, scan time and length, qualitative and quantitative noise levels, volumetric CT dose index (CTDIvol), dose length product (DLP), and size-specific dose estimations were compared between groups. Results The mean scan time of high-pitch CT protocol was shorter than control protocol (1.66 ± 0.31 vs. 4.1 ± 0.75 s; p < 0.001). The high-pitch protocol reduced the radiation dose by 48% (CTDIvol and DLP values 0.94 mGy and 32.2 mGycm vs. 1.59 mGy and 61.5 mGy-cm; p < 0.001, respectively). Although image noise was higher with high-pitch acquisition, there was no significant effect on diagnostic confidence. Voluntary and involuntary artifacts were less frequent in high-pitch protocol (p < 0.001). Interobserver agreement was moderate in terms of artifact and very good in terms of diagnostic confidence assessment. Conclusion High-pitch acquisition protocol by DSCT yields significant radiation dose reduction without compromising image quality and diagnostic confidence for pediatric abdomen imaging.
This is a cross-sectional descriptive study objectives to describe normal development of thoracic... more This is a cross-sectional descriptive study objectives to describe normal development of thoracic vertebrae during childhood and document contribution of individual vertebral shape to the sagittal alignment. Sagittal spinal alignment changes during growth. The changes in sagittal alignment during adolescent growth spurt as well as the individual shapes of thoracic vertebrae have been implicated as factors for the development of adolescent idiopathic scoliosis (AIS). The contribution of individual vertebral shape to the sagittal alignment and the changes in the vertebral shape with growth is not known. Sagittal computed tomographic (CT) scans of thoracic vertebrae were examined in children without any evidence of spinal deformity. Vertical distances between the endplates at the most anterior and most posterior sides of vertebral body were measured as anterior vertebral height (aVH) and posterior vertebral height (pVH), respectively. There were a total of 133 CT scans done on 71 male and 62 female children. The children were grouped as follows: Group I (0-2 years of age), Group II (3-6 years of age), Group III (7-9 years of age), Group IV (10-12 years of age), and Group V (13-16 years of age). A-P ratios of vertebral heights were grouped as T1-T5, T6-T8, and T9-T12. Measurements demonstrated that the anterior and posterior heights in each vertebra grew longitudinally and consistently with increasing age. The aVH/pVH ratio of each individual vertebra showed no significant difference according to age. Measurements of thoracic vertebrae on sagittal spinal CT images did not show any differences in the relative growth and heights of the anterior versus posterior walls of the vertebral bodies in any of the segments in any age or age group. The sagittal alignment changes during growth are likely related to maintenance of sagittal balance rather than the shapes of individual vertebrae. Level II.
Cervical fractures are rare in paediatric population. In younger children, cervical fractures usu... more Cervical fractures are rare in paediatric population. In younger children, cervical fractures usually occur above the level of C4; whereas in older population, fractures or dislocations more commonly involve the lower cervical spine. Greater elasticity of intervertebral ligaments and also the spinal vertebrae explains why cervical fractures in paediatric ages are rare. The injury usually results from a symmetric or asymmetric axial loading. In paediatric cases, most fractures occur through the synchondroses which are the weakest links of the atlas. The prognosis depends on the severity of the spinal cord injury. In this case, we presented an anterior fracture in synchondrosis of atlas after falling on head treated with cervical collar. There was no neurologic deficit for the following 2 years.
Lipomatosis is a benign and non-encapsulated mature form of fat tissue proliferation, which can b... more Lipomatosis is a benign and non-encapsulated mature form of fat tissue proliferation, which can be isolated or multiple, symmetrical or infiltrative, and may be associated with several syndromes. Lipomatosis has been reported to involve almost every part and organ in the body. In this review, we present imaging findings at common locations of lipomatosis and summarize lipomatosis-related syndromes.
To our knowledge, the utility of coronary covered stents in the treatment of atherosclerotic caro... more To our knowledge, the utility of coronary covered stents in the treatment of atherosclerotic carotid artery stenosis has not been defined in the English-language literature. Covered stents may prevent microembolic complications in select atherosclerotic carotid lesions, as they exclude the atherosclerotic lesion from the circulation by pressing the plaque against the vessel wall. Our early clinical experience has shown that use of these stents can be a therapeutic option in select cases of atherosclerotic stenosis of the cervical internal carotid artery.
Vertebral vacuum sign is an uncommon finding, which can easily mimic the air within the disc and ... more Vertebral vacuum sign is an uncommon finding, which can easily mimic the air within the disc and can be overlooked. We present a case of intravertebral vacuum phenomenon with exquisite multidetector computed tomography and magnetic resonance imaging findings.
Purpose: This retrospective study evaluated the unenhanced multi-detector computed tomography (MD... more Purpose: This retrospective study evaluated the unenhanced multi-detector computed tomography (MDCT) findings of urinary system calculi and the secondary signs associated with ureteral stones in children. Materials and methods: The study included 87 children (54 boys, 32 girls) with a mean age of 89 months (range: 5 months to 16 years) who were referred to us from various departments and were evaluated with unenhanced MDCT between January 2004 and June 2005. The patients were retrospectively evaluated by 2 radiology specialists by means of PACS (picture archiving and communication systems) with regard to the presence of stones, and localization and secondary signs associated with ureteral stones, such as hydronephrosis, proximal ureteral dilatation, unilateral renal enlargement, perinephric edema, tissue rim sign, decreased renal density, and periureteral edema. Patients were scanned by 4- and 16-slice MDCT. Results: Urinary system calculi were detected in 47 (54%) children. An isolated stone in the urinary bladder was detected in one patient. In the remaining 46 children, 43 of the detected stones were renal stones and 23 of them were ureteral stones. Secondary signs associated with ureteral stones were detected in 69.6% of children who had ureteral stones. Conclusion: MDCT provided evaluation of the secondary signs associated with ureteral stones as well as the direct visualization of the stones in cases with urinary stone disease. The ability of MDCT to detect the secondary signs associated with ureteral stones supported the diagnoses and may aid in diagnosis when difficulties are present.
Journal of stroke and cerebrovascular diseases, 2014
The use of narrower window width settings on computed tomography (CT) improves sensitivity for de... more The use of narrower window width settings on computed tomography (CT) improves sensitivity for detection of early ischemic changes in acute ischemic stroke. This study analyzed the effect of optimization of window settings on the accuracy of Alberta Stroke Program Early Computed Tomography Score (ASPECTS) performed on noncontrast CT (NCCT) and CT angiography source images (CTA-SI). ASPECTS was calculated on NCCT and CTA-SI with standard and optimized window width/center settings in a consecutive series of patients with acute ishcemic stroke. The difference between CT-based ASPECTS and ASPECTS performed on follow-up magnetic resonance imaging (MRI) were calculated to determine the disparity between initial estimates of the extent of ischemia on CT and follow-up lesion imaging by MRI. Forty-four patients were included into the study. The mean difference with respect to follow-up MRI-ASPECTS was 4.1 6 2.2 for standard NCCT-ASPECTS, 3.7 6 2.3 for optimized NCCT-ASPECTS, 3.0 6 2.2 for standard CTA-SI-ASPECTS, and 2.7 6 2.1 for optimized CTA-SI-ASPECTS. The improvement introduced by the optimization of window settings and use of CTA-SI was statistically significant (P ,.01). Our data indicate that the accuracy of ASPECTS is improved with optimized window display settings. This improvement is irrespective of experience or specialty of the rater performing the assessment.
The aim of this study was to evaluate efficiency of embolotherapy in management of retroperitonea... more The aim of this study was to evaluate efficiency of embolotherapy in management of retroperitoneal bleedings. A total of 16 patients with retroperitoneal bleeding who underwent angiography followed by transcatheter embolization within a 4-year period in a single centre were reviewed retrospectively. Electronic charts as well as procedural reports were reviewed to assess immediate angiographic findings and results of embolization. Computed tomography was carried out in eight patients. All computed tomography scans showed retroperitoneal haematoma. In addition, contrast material extravasation consistent with active bleeding was seen in two patients and pseudoaneurysm in one. In the remaining eight patients, diagnosis of retroperitoneal bleeding was established based on combined ultrasound and clinical findings. The technical success rate for selective embolotherapy was 100%. Five of these 16 patients (three women and 13 men) had lumbar artery injury; 10 patients were associated with renal artery injury and one had bilateral internal iliac artery injury. Angiography showed active extravasation, pseudoaneurysm and arteriovenous fistula. For embolization, coils were used in six patients and N-butyl-2-cyanoacrylate in the remaining 10 patients. Four patients died within 1 month of embolotherapy. Transcatheter embolotherapy appears to be a life-saving, safe and effective treatment for retroperitoneal bleedings that may be carried out in emergency situations in haemodynamically unstable patients.
FIG. 1 (a-e). Fusion axial slice formed by dual-energy CT (a), 190 keV axial slice (b), 40 keV ax... more FIG. 1 (a-e). Fusion axial slice formed by dual-energy CT (a), 190 keV axial slice (b), 40 keV axial slice (c), iodine-extracted axial slice (d), and iodine map (e). On the high keV (b) and iodine-extracted slices (d), the lesion (circle) is not visible, whereas on the fusion axial slice (a), distinguishing it from the surrounding tissue is quite difficult. The lesion can be easily noticed when looking at the low-voltage image (c) and iodine map images (e)
CardioVascular and Interventional Radiology, Sep 29, 2005
An 84-year-old woman with a history of hypertension and coronary artery disease was admitted with... more An 84-year-old woman with a history of hypertension and coronary artery disease was admitted with a progressively worsening diffuse abdominal pain. Computed tomography scan of the abdomen and angiography revealed occlusion of the origin and proximal portion of superior mesenteric artery. Aortography also showed severe origin stenosis of inferior mesenteric artery and that the distal part of the superior mesenteric artery was supplied by a prominent marginal artery of Drummond. Patient was effectively treated with percutaneous transluminal angioplasty and stenting of the inferior mesenteric artery. Follow-up imaging studies demonstrated patency of the stent and spontaneous recanalization of superior mesenteric artery occlusion.
We studied the proportion of normal appendices, identified on non-contrast MDCT scans of the abdo... more We studied the proportion of normal appendices, identified on non-contrast MDCT scans of the abdomen and pelvis in children with possible renal stones. A total of 105 patients were included in the study, comprising 40 girls (38%) and 65 (62%) boys, with a mean age of 7.3 years. Non-enhanced abdominal computed tomographies were evaluated retrospectively, and the visualization, location, contents, diameter of the appendix, and the amount of abdominal fat were recorded. The appendix was clearly distinguished in 72 patients (68.5%). The difference in appendix visualization rates between patients with low and medium amounts of abdominal fat was statistically significant (p &lt; 0.001). Visualization increased with age. The greatest external diameter was between 2.8 and 10 mm, with a mean of 5 +/- 1.34 mm. MDCT without contrast will be more useful when used in patients of 6 years old and over, for visualization of the appendix. A better visualization of retrocaecal appendix by MDCT provides a greater advantage over US. Prospective comparative studies will determine the role of this method in the diagnosis of acute appendicitis in pediatric patients.
Bleeding pulmonary artery pseudoaneurysm secondary to squamous cell lung cancer: computed tomogra... more Bleeding pulmonary artery pseudoaneurysm secondary to squamous cell lung cancer: computed tomography findings and endovascular management. Acta Radiol 2006;47:944-946. A case of bleeding pulmonary artery pseudoaneurysm secondary to squamous cell lung cancer is reported. The patient presented with massive hemoptysis, diagnosis was made with multidetector computed tomography, and the pseudoaneurysm was successfully embolized with platinum coils. Hemoptysis ceased following the procedure.
An unusual variation of the iliac veins was detected by computed tomography (CT) angiography in a... more An unusual variation of the iliac veins was detected by computed tomography (CT) angiography in a 35-year-old man. In coronal CT reconstructions, it was shown that the right internal iliac vein of this patient crossed to the left side and drained to the left common iliac vein. This variation is important in retroperitoneal, laparoscopic and orthopedic surgery. We present the CT findings and discuss the embryological origin of this unusual congenital anomaly. Veine iliaque interne droite tributaire de la veine iliaque commune gauche. Un cas de´couvert par angio-scanner Re´sume´Une variation inhabituelle des veines iliaques a e´te´de´couverte par tomodensitome´trie chez un malade de 35 ans. Les reconstructions coronales ont montre´que la veine iliaque interne droite du patient croisait la ligne me´diane vers la gauche pour se drainer dans la veine iliaque commune gauche. Cette variation est importante a`connaıˆtre en chirurgie re´tro-pe´ritone´ale, laparoscopique et orthope´dique. Nous pre´sentons les documents obtenus par tomodensitome´trie et discutons l'origine embryologique de cette anomalie conge´nitale rare.
Objectives There is increasing evidence that thrombotic events occur in patients with coronavirus... more Objectives There is increasing evidence that thrombotic events occur in patients with coronavirus disease (COVID-19). We evaluated lung and kidney perfusion abnormalities in patients with COVID-19 by dual-energy computed tomography (DECT) and investigated the role of perfusion abnormalities on disease severity as a sign of microvascular obstruction. Methods Thirty-one patients with COVID-19 who underwent pulmonary DECT angiography and were suspected of having pulmonary thromboembolism were included. Pulmonary and kidney images were reviewed. Patient characteristics and laboratory findings were compared between those with and without lung perfusion deficits (PDs). Results DECT images showed PDs in eight patients (25.8%), which were not overlapping with areas of ground-glass opacity or consolidation. Among these patients, two had pulmonary thromboembolism confirmed by CT angiography. Patients with PDs had a longer hospital stay (p = 0.14), higher intensive care unit admission rates (p = 0.02), and more severe disease (p = 0.01). In the PD group, serum ferritin, aspartate aminotransferase, fibrinogen, D-dimer, C-reactive protein, and troponin levels were significantly higher, whereas albumin level was lower (p < 0.05). D-dimer levels ≥ 0.485 μg/L predicted PD with 100% specificity and 87% sensitivity. Renal iodine maps showed heterogeneous enhancement consistent with perfusion abnormalities in 13 patients (50%) with lower sodium levels (p = 0.03). Conclusions We found that a large proportion of patients with mild-to-moderate COVID-19 had PDs in their lungs and kidneys, which may be suggestive of the presence of systemic microangiopathy with micro-thrombosis. These findings help in understanding the physiology of hypoxemia and may have implications in the management of patients with COVID-19, such as early indications of thromboprophylaxis or anticoagulants and optimizing oxygenation strategies. Key Points • Pulmonary perfusion abnormalities in COVID-19 patients, associated with disease severity, can be detected by pulmonary DECT. • A cutoff value of 0.485 μg/L for D-dimer plasma levels predicted lung perfusion deficits with 100% specificity and 87% sensitivity (AUROC, 0.957). • Perfusion abnormalities in the kidney are suggestive of a subclinical systemic microvascular obstruction in these patients.
Purpose To investigate feasibility of high-pitch acquisition protocol for imaging of pediatric ab... more Purpose To investigate feasibility of high-pitch acquisition protocol for imaging of pediatric abdomen. Materials and methods The study group consisted of 90 patients scanned with high-pitch acquisition protocol (pitch = 3) by 64-slice dual-source CT (DSCT) scanner. Fifty-four patients scanned with standard protocol (pitch = 1.5) by 16-slice singlesource CT scanner comprised the control group. Anteroposterior and lateral diameters of abdomen, effective diameter, scan time and length, qualitative and quantitative noise levels, volumetric CT dose index (CTDIvol), dose length product (DLP), and size-specific dose estimations were compared between groups. Results The mean scan time of high-pitch CT protocol was shorter than control protocol (1.66 ± 0.31 vs. 4.1 ± 0.75 s; p < 0.001). The high-pitch protocol reduced the radiation dose by 48% (CTDIvol and DLP values 0.94 mGy and 32.2 mGycm vs. 1.59 mGy and 61.5 mGy-cm; p < 0.001, respectively). Although image noise was higher with high-pitch acquisition, there was no significant effect on diagnostic confidence. Voluntary and involuntary artifacts were less frequent in high-pitch protocol (p < 0.001). Interobserver agreement was moderate in terms of artifact and very good in terms of diagnostic confidence assessment. Conclusion High-pitch acquisition protocol by DSCT yields significant radiation dose reduction without compromising image quality and diagnostic confidence for pediatric abdomen imaging.
This is a cross-sectional descriptive study objectives to describe normal development of thoracic... more This is a cross-sectional descriptive study objectives to describe normal development of thoracic vertebrae during childhood and document contribution of individual vertebral shape to the sagittal alignment. Sagittal spinal alignment changes during growth. The changes in sagittal alignment during adolescent growth spurt as well as the individual shapes of thoracic vertebrae have been implicated as factors for the development of adolescent idiopathic scoliosis (AIS). The contribution of individual vertebral shape to the sagittal alignment and the changes in the vertebral shape with growth is not known. Sagittal computed tomographic (CT) scans of thoracic vertebrae were examined in children without any evidence of spinal deformity. Vertical distances between the endplates at the most anterior and most posterior sides of vertebral body were measured as anterior vertebral height (aVH) and posterior vertebral height (pVH), respectively. There were a total of 133 CT scans done on 71 male and 62 female children. The children were grouped as follows: Group I (0-2 years of age), Group II (3-6 years of age), Group III (7-9 years of age), Group IV (10-12 years of age), and Group V (13-16 years of age). A-P ratios of vertebral heights were grouped as T1-T5, T6-T8, and T9-T12. Measurements demonstrated that the anterior and posterior heights in each vertebra grew longitudinally and consistently with increasing age. The aVH/pVH ratio of each individual vertebra showed no significant difference according to age. Measurements of thoracic vertebrae on sagittal spinal CT images did not show any differences in the relative growth and heights of the anterior versus posterior walls of the vertebral bodies in any of the segments in any age or age group. The sagittal alignment changes during growth are likely related to maintenance of sagittal balance rather than the shapes of individual vertebrae. Level II.
Cervical fractures are rare in paediatric population. In younger children, cervical fractures usu... more Cervical fractures are rare in paediatric population. In younger children, cervical fractures usually occur above the level of C4; whereas in older population, fractures or dislocations more commonly involve the lower cervical spine. Greater elasticity of intervertebral ligaments and also the spinal vertebrae explains why cervical fractures in paediatric ages are rare. The injury usually results from a symmetric or asymmetric axial loading. In paediatric cases, most fractures occur through the synchondroses which are the weakest links of the atlas. The prognosis depends on the severity of the spinal cord injury. In this case, we presented an anterior fracture in synchondrosis of atlas after falling on head treated with cervical collar. There was no neurologic deficit for the following 2 years.
Lipomatosis is a benign and non-encapsulated mature form of fat tissue proliferation, which can b... more Lipomatosis is a benign and non-encapsulated mature form of fat tissue proliferation, which can be isolated or multiple, symmetrical or infiltrative, and may be associated with several syndromes. Lipomatosis has been reported to involve almost every part and organ in the body. In this review, we present imaging findings at common locations of lipomatosis and summarize lipomatosis-related syndromes.
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Papers by Erhan Akpinar