Pitfalls, artifacts and remedies in multi-detector row CT coronary angiography

Successful interpretation of the CT coronary angiography that requires knowledge of its potential pitfalls and familiarity with methods that minimize or avoid them. A total number of 60 consecutive patients scheduled for elective non-urgent conventional coronary angiography for known or suspected coronary artery disease were enrolled for 16 channel multi-slice CT angiography between Jan 2006 to Jan 2007. All patients underwent MSCT coronary angiography. Ten patients had performed percutaneous interventions and 15 patients had done coronary artery bypass graft [CABG]. Five of the 60 patients were excluded from the study because of technical difficulties or failure of data acquisition. So, 55 patients [44 males and 11 females] were included in the study. Their mean age was 55 years ranging between 48 years and 64 years. There were a total number of 44 males and 11 females. 14 coronary examinations showed respiratory motion related artifacts and 5 with voluntary body motion related artifacts. 13 examinations were affected by the post-operative surgical metallic artifacts and by coronary implanted stents. Familiarity with the pitfalls of coronary angiography with multi-detector now CT, couples with knowledge of both anatomy and anatomic variants of the coronary arteries can almost always help radiologists avoid errors in the diagnosis of coronary artery stenosis

Diagnostic value of cardiac troponin I in patients with pulmonary embolism

The main aim of this study is to test the value of estimation of serum troponin I as a marker of right ventricular ischaemia and /or dysfunction in diagnosis of patients with pulmonary embolism aiming for more accurate risk stratification of these patients to detect those who are in need for more aggressive therapy. 22 patients 14 females and 8 males with confirmed pulmonary embolism based mainly on ventilation perfusion lung scan in 14/22 cases, spiral CT angiography in 1 case and combined echocardiographic evidence of right ventricular strain in addition to clinical presentation of acute dyspnoea in absence of major chronic obstructive pulmonary disease in seven cases. Patients were divided into two main groups according to both their haemodynamic state and /or the presence of abnormal echocardiographic parameters. Group A includes 8 patients with normal haemodynamic status and echocardiographic parameters; group B includes 14 patients with abnormal echocardiographic parameters of the right ventricle. They were further subdivided according to their haemodynamic status into 6/14 patients [43%] with abnormal haemodynamic status and 8/14 patients [57%] with normal haemodynamics. Serum troponin I was considered elevated above 0. IMcg/L, it was found restrictly elevated in 11/14 of patients [79%] and borderline in 3 patients [21%] in group B compared to 0/8 in group A, the difference was statistically significant [p=0.004]. Serum Troponin I was found to be statistically significant higher in patients with abnormal haemodynamics compared to patients with normal haemodynamics in group B [p=0.04] Troponin I was found to be significantly positively correlated with right ventricular size [r 0.529, p<0.01], pulmonary artery pressure [r 0.659, p<0.001]. Serum troponin I may be a helpful diagnostic tool in patients with pulmonary embolism and may improve the risk stratification of these patients as its elevation is significantly correlated with other adverse prognostic factors in these patients such as haemodynamic status, right ventricular size and pulmonary artery pressure and its elevation even in absence of haemodynamic alteration may point to aggressive intervention in these patients