128-detector-row computed tomography coronary angiography assessing differences in morphology and distribution of atherosclerotic plaques between patients with and without pre-test probability of significant coronary artery disease.

OBJECTIVES: To evaluate and compare morphology, distribution and orientation of atherosclerotic plaques at the coronary arteries between patients with low and intermediate pre-test probability of significant coronary artery disease (CAD) by non-invasive coronary angiography using 128-Multi Detector Computed Tomography (MDCT). MATERIALS AND METHODS: The study included 120 patients divided into two groups according to their clinical pre-test probability of having significant CAD: 38 patients (group A) with intermediate pre-test probability and 82 patients (group B) with low pre-test probability of significant CAD. Atherosclerotic plaques were characterized according to their morphology, distribution and orientation. RESULTS: A total of 482 plaques were analyzed. In group A, we found statistically significant higher percentages of RCA plaques (p=0.0005), of concentric (p<0.0001) and non-branching (p=0.013) plaques, of myocardial plaques (p=0.029), of plaques in distal RCA (p=0.0009) and distal LAD (p=0.001). In group B, we found statistically significant higher percentages of LAD plaques (p<0.0001), of eccentric (p<0.0001) and branching (p=0.013) plaques, of lateral plaques (p=0.012), of Medina 1.0.0 (p=0.0069), 0.1.0 (p=0.022) and 1.1.1 (p=0.0068) branching plaques, and of plaques in proximal LAD (p=0.02). CONCLUSION: 128-MDCT coronary angiography can provide important information on morphology and distribution of atherosclerotic plaques and may in the future play a potential role in patient management.

The roots of radiology in Greece.

This article presents as reliably as possible the roots of the Radiology specialty in Greece, from the time of the discovery of X-rays by WC Roentgen. It mentions the most important dates relevant to the foundation of the specialty of Radiology in Greece.

Symptomatic partial rotator cuff tears: diagnostic performance of ultrasound and magnetic resonance imaging with surgical correlation.

BACKGROUND: The painful shoulder is a relatively common clinical entity that may be attributed to a variety of pathologies, including partial rotator cuff tears. Conservative treatment or surgical intervention may be offered, depending on the extent of the partial tear and the degree of patient discomfort. PURPOSE: To apply ultrasound (US) imaging in order to evaluate the prevalence of partial rotator cuff tears in patients with painful shoulders. MATERIAL AND METHODS: Fifty-six patients (17 men, 39 women; mean age 53.7 years) were included in the study, with symptomatic impingement syndrome of the shoulder after having failed to respond to conservative treatment. All patients underwent US and magnetic resonance imaging (MRI) scans prior to surgical intervention. RESULTS: Arthroscopy or mini-open surgery revealed 53 cases with partial tears of the rotator cuff and three with extensive tendinopathy. Both imaging modalities detected successfully 44 cases of partial tears of the supraspinatus tendon. US imaging yielded a sensitivity of 95.6%, a specificity of 70%, an accuracy of 91%, and a positive predictive accuracy of 93.6%. The corresponding values for MRI were 97.7%, 63.6%, 91%, and 91.7%, respectively. CONCLUSION: US imaging can be considered almost equally effective in detecting partial tears of the rotator cuff compared to MRI, particularly located in the area of the supraspinatus tendon. MRI may be reserved for doubtful or complex cases, in which delineation of adjacent structures is mandatory prior to surgical intervention.

The role of Doppler Perfusion Index as screening test in the characterization of focal liver lesions.

PURPOSE: Doppler Perfusion Index (DPI) has been used in the detection of overt liver metastatic disease. In the present prospective study we evaluated the use of DPI in the differential diagnosis of liver tumours. MATERIALS AND METHODS: We have included in our study 76 patients with focal hepatic lesion and 39 subjects as control group. All patients were evaluated by Color Doppler Ultrasound, and/or Spiral Computerised Tomography, Magnetic Resonance Imaging and biopsy. The radiologist performed DPI measurements was blind from the final diagnosis of the other methods. RESULTS: DPI measurements in the control group ranged from 0.07 to 0.22 (mean value 0.14), in 42 cases with benign lesions (group A) ranged from 0.05 to 0.53 (mean 0.15) and in 34 cases with malignant lesions (group B) ranged from 0.39 to 0.75 (mean 0.53). There was a statistically significant difference in DPI measurements between the control group and group B. CONCLUSIONS: Our results suggest that the DPI may differentiate malignant from benign focal hepatic lesions and therefore can be used as a screening test in the routine clinical practice.

The role of 3D-computed tomography angiography (3D-CTA) in investigation of spontaneous subarachnoid haemorrhage: comparison with digital subtraction angiography (DSA) and surgical findings.

Spontaneous subarachnoid haemorrhage is a clinical condition that may be attributed to various underlying causes, such as rupture of intracranial aneurysms and arteriovenous malformations (AVMs). Suspected cerebrovascular abnormalities can be detected either with digital subtraction angiography (DSA) or with computed tomography angiography (CTA) combined with postprocessing tools, namely multiplanar reformation, maximum intensity projection, shaded surface display, virtual endoscopy and direct volume rendering. We prospectively studied a group of 205 patients with spontaneous subarachnoid haemorrhage. One-hundred-ninety-eight patients underwent both DSA and CTA, and formed our study group. Patients with intracranial aneurysms underwent surgical or endovascualar treatment. DSA was negative for 35 patients, detected 178/179 aneurysms and 15 AVMs. CTA correctly detected 176/179 aneurysms and all 15 cases of AVMs, whereas it was negative in 35 cases. After 3D reconstruction the size, location and the relationship to the parent vessel of the aneurysms, the extent of the AVMs with the main feeding vessel(s), nidus and draining veins were reliably shown by CTA, although DSA provided more anatomic details related to the anatomy of the adjacent vessels. The accuracy, sensitivity, positive predictive accuracy and negative predictive accuracy for CTA was 98, 97.9, 100 and 94.3% and for DSA was 99, 99.3, 100 and 98%, respectively. It is suggested that CTA is a reliable alternative to DSA in detecting intracranial aneurysms. The role of CTA in demonstrating AVMs can be considered complementary to that of DSA.

Imaging modalities for renal artery stenosis in suspected renovascular hypertension: prospective intraindividual comparison of color Doppler US, CT angiography, GD-enhanced MR angiography, and digital substraction angiography.

The aim of the study was to evaluate the diagnostic accuracy of Color Doppler US, CT Angiography (CTA), and GD-enhanced MR Angiography (MRA) compared with digital subtraction angiography (DSA) for the detection of renal artery stenosis in patients with clinically suspected renovascular hypertension. Fifty-eight patients with suspected renovascular hypertension were enrolled in the study. All patients underwent Color Doppler US, CTA and GD-enhanced MRA. DSA was the gold standard method for the number of renal arteries, existence and degree of stenosis, or evidence of fibromuscular dysplasia. DSA depicted 132 renal arteries, 16 stenoses, and 4 arteries with fibromuscular dysplasia. Color Doppler US failed to detect 1 main and 14 polar arteries. CTA depicted all main renal arteries and 7/16 polar arteries, but failed to detect stenosis in two accessory vessels. Likewise, MRA did not detect stenotic accessory renal arteries, depicted 9/16 polar renal arteries, but missed two main renal arteries. All methods depicted the four main renal arteries with fibromuscular dysplasia. The overall sensitivity, specificity, and positive and negative predictive accuracy were 75%, 89.6%, 60% and 94.6%, respectively, for color Doppler US; 94%, 93%, 71%, and 99%, respectively, for CTA; and 90%, 94.1%, 75%, and 98%, respectively, for GD-enhanced MRA. CTA and GD-enhanced MRA have comparable and satisfactory results with respect to the negative predictive accuracy of the suspected renal artery stenosis. The concept of an imaging algorithm including US as screening test when appropriate and CTA or MRA as the second step-procedure is suggested. Therefore, DSA may be reserved for cases with major discrepancies or therapeutic interventions.

Contrast-enhanced sonographic detection of vesicoureteral reflux in children: comparison with voiding cystourethrography.

PURPOSE: Prospective evaluation of contrast-enhanced sonography (CES) as an alternative to radiographic voiding cystourethrography (VCUG) in the detection of vesicoureteral reflux (VUR). MATERIALS AND METHODS: Seventy-six children (age range: 0 - 9 years, mean age 1.4 years) with suspicion of VUR due to various indications were examined by contrast-enhanced sonography (CES) and VCUG. CES examination was performed after instillation of Levovist into the catheterized urinary bladder, which had been prefilled with normal saline. Reflux was diagnosed when hyperechogenic microbubbles were observed in the renal units. Thereafter, VCUG was performed in all patients through the same catheter. CES findings were compared to the results of VCUG. RESULTS: CES showed VUR in 24 renal units whereas VCUG showed reflux in 18 renal units. With regard to the presence of VUR, the findings obtained by both methods were concordant in 17 renal units. Taking VCUG as the reference standard, the sensitivity of CES was 96 %, the specificity was 94.8 %, the positive predictive value 77.4 % and the negative predictive value 99.2 %. Additionally, McNemar test showed that CES detected a statistically significant higher number of renal units with VUR (p < 0.05). CONCLUSION: It is suggested that CES is an accurate and reliable imaging modality for the detection of VUR, although it cannot replace VCUG in some cases. In addition, CES can be recommended in the follow-up of VUR, reducing the number of radiographic investigations.