A Contrast-Enhanced MDCT Study on the Morphology of Renal Vessels, Their Variations and Clinical Implications

Introduction: The kidneys—the main organs of the excretory system, are supplied by a paired renal artery, originating from the Abdominal Aorta at the level of a disc between L1 and L2 and drained by a paired renal vein exiting from the hilum of the kidney to the Inferior vena cava. Aim: To evaluate the morphology of renal vessels, their variations & clinical implications during renal surgeries in the subjects of the North India population by contrast-enhanced MDCT. Materials and Method: The present study was conceptualized & carried out in the Department of Anatomy, in collaboration with the Department of Radiodiagnosis, Santosh Medical College & Hospital, Ghaziabad and from Dr. O.P Gupta Imaging Centre, Meerut. This study was performed on the 108 patients who were referred for abdominal CECT examination with suspected abdominal pathologies. Contrast-enhanced MDCT scan images of the Abdomen were reviewed for normal anatomy of renal vessels and their variants. Result: Out of 108 patients, anatomical variations of the renal vessel were found in 72 (66.66%) patients. Variations of the renal artery were found in 56 patients (51.85%). Out of these 56 patients, 47 had supplementary renal artery, 17 had early branching of the renal artery and 8 patients had both supplementary and early branching of the renal artery. Supplementary renal arteries were seen in 15 patients on the right side, 16 patients on the left side & 16 patients bilaterally. Earlier branching of the renal artery was found in 9 patients on the right side, 10 patients on the left side and in 2 patients bilaterally. Variations of the renal vein were more commonly found on the right side, late renal vein confluence was seen in 28 (25.92%) patients and supplementary renal veins in 9 (8.3%) patients. On the left side, 2 (1.85%) patients had late renal vein confluence and 2 (1.85%) patients had retroaortic vein. Conclusion: Variations of the renal artery are found frequently. Morphological evaluation of renal vessels is useful for planning and performing the endovascular, laparoscopic and urological procedure.

The morphometrical analysis of the external carotid artery and its branches with multidetector computerized tomography angiography technique / Análisis morfométrico de la arteria carótida externa y sus ramas mediante la técnica de angiografía por tomografía computarizada multidetector

The external carotid artery (ECA) is the main artery of the head and the neck region. Carotid bifurcation (CB), which is one of the place where the atherosclerotic plaques are most commonly seen. The surgical procedure of these plaques which causes cerebral vascular accident (CVA) is carotid endarterectomy. In this surgical procedure, the knowledge of the anatomical courses and variations of the carotid artery increased the surgery performance. In our study, we aimed to introduce the course, the location and the variation of the ECA's and their branches. This study is carried out on multidetector computerized tomography angiography of the ECA's of 50 men and 50 women, totally 200 ECA's (100 right, 100 left). The measurement of the inner diameter of the common carotid artery (CCA) and the ECA was evaluated. The location of the CB was determined and its vertical distance to the gonion measured. We found that the superior thyroid artery (STA) originated from the CCA, the CB and the ECA. The vertical distances between the CB and the STA, lingual (LA), facial (FA) occipital (OA) were measured. The ECA and its branches were recorded. We believe that the assessment of the ECA morphometrically may comprise control groups of diseases related to the vessel diameter and this data may be used as reference in clinic and surgery. Knowing the anatomical details and variations is vital to prevent unpredictable complications in surgery.

La arteria carótida externa (ACE) es la principal arteria de la cabeza y de la región del cuello. La bifurcación carotídea (BC) es uno de los lugares donde las placas ateroscleróticas son más frecuentes. El procedimiento quirúrgico para tratar estas placas que causan el accidente vascular cerebral (AVC) es la endarterectomía carotídea. En este procedimiento quirúrgico, el conocimiento de los cursos anatómicos y variaciones de la arteria carótida aumenta el rendimiento de la cirugía. El objetivo de nuestro estudio fue presentar el trayecto, localización y variación de la ACE y sus ramas. El estudio se realizó mediante angiografía multidetector por tomografía computarizada de la ACE de 50 hombres y 50 mujeres, totalizando 200 ACE (100 derechas y 100 izquierdas). Se evaluaron el diámetro interior de la arteria carótida común (ACC) y la ACE. Se determinó la ubicación de la BC y se midió la distancia vertical hasta el gonion. Se observó que la arteria tiroidea superior (ATS) se originó desde la ACC, la BC y la ACA. Las distancias verticales entre la BC, y las arterias tiroídea superior, lingual (AL), facial (AF) y occipital (AO) fueron medidas. La ACE y sus ramas se registraron. Creemos que la evaluación morfométrica de la ACE puede comprender grupos de control de las enfermedades relacionadas con el diámetro de los vasos, y estos datos pueden ser utilizados como referencia clínica y quirúrgica. El conocimiento de los detalles anatómicos y variaciones es de vital importancia para evitar complicaciones imprevisibles en la cirugía.

Developmental anomalies of bronchial tree: a multidetector computerized tomography study / Anomalías del desarrollo del árbol bronquial: un estudio mediante tomografía computarizada multidetector

Anomalies of the bronchial tree may cause recurrent acute pulmonary infection and persistent obstruction symptoms. The developmental anomalies of the bronchial tree were presented mostly as case reports with an accompanying anomaly. However in this study, these anomalies were detected in multidetector computerized tomography (MDCT) images which have no reported pathology. Thoracic MDCT images of 400 patients (0-74 years old, 224 male and 176 female) were evaluated. Four tracheal bronchus (1percent) were detected. Three of them were displaced type, one of them was pig bronchus. And two accessory cardiac bronchus (0,5 percent) originated from medial wall of the intermediate bronchus were detected. According to our findings, incidence of tracheal bronchus and accessory cardiac bronchus seems to be higher in Turkish population.

Las anomalías del árbol bronquial pueden causar una infección pulmonar aguda recurrente y síntomas de obstrucción persistente. Las anomalías del desarrollo del árbol bronquial se presentan principalmente como informes de casos con una anomalía de acompañante. Sin embargo, en este estudio se detectaron estas anomalías en las imágenes de tomografía computarizada multidetector (TCMD), donde no se habían informado esta patología. Se evaluaron las imágenes de TCMD torácica de 400 pacientes (0-74 años, 224 hombres y 176 mujeres). Se detectaron cuatro bronquios traqueales (1 por ciento). Tres de ellos fueron de tipo desplazado, uno fue tipo bronquio de cerdo, y dos bronquio cardiaco accesorio (0,5 por ciento), originados de la pared medial del bronquio intermedio. De acuerdo con nuestros resultados, la incidencia de bronquio traqueal y bronquios cardiacos accesorios parecen ser mayor en la población turca.

Role of Multidetector Computerized Tomography (MDCT) in Identification of Common Bile Duct Stone: Comparison with ERCP / 대한소화기내시경학회지

BACKGROUND/AIMS: MDCT, which provides high resolution and various reconstructing images, has recently become widely available and is a promising tool for imaging the bile duct with precision. In order to evaluate the diagnostic value of multidetector computerized tomography (MDCT) for a common bile duct (CBD) stone, this study compared the diagnostic accuracy of MDCT with that of ERCP. METHODS: The medical records of the patients undergoing both MDCT and ERCP consecutively from June 2006 to January 2007 were retrospectively reviewed. One hundred and sixty four patients (164 cases) were enrolled in this study. The final diagnoses were based mainly on the ERCP findings. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of MDCT and ERCP for choledocholithiasis were identified and compared. RESULTS: Of the 164 cases, 47 cases were diagnosed with choledocholithiasis. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for choledocholithiasis were 89.4%, 98.3%, 95.5%, 95.8%, 95.7% in MDCT and 97.9%, 99.1%, 97.9%, 99.1%, 98.8% in ERCP, respectively. There were no statistically significant differences in the diagnostic accuracy between the two methods (p=0.206). CONCLUSIONS: MDCT has high sensitivity and specificity for diagnosing stones in the bile duct and should be performed in preference to ERCP in patients suspected of having choledocholithiasis.