Is there a role for DWI in the diagnosis of sacroiliitis based on ASAS criteria?

PURPOSE: Sacroiliitis based on MRI is one of the main diagnostic criteria of axial spondyloarthritis (SpA). Our purpose was to assess (a) whether apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI) differ between regions of bone marrow edema (BME) and subchondral normal-appearing bone marrow (NABM) in active sacroiliitis, (b) whether ADC values can differentiate early SpA and chronic SpA, both in the active and inactive phase, and (c) whether ADC values are related to laboratory findings. MATERIALS AND METHODS: 47 patients (24 female, 23 male, mean age: 38.53 years) with the diagnosis of SpA were included in this retrospective study. 20 age- and sex-matched subjects without SpA constituted the control group. ADC measurements were taken from all lesions and NABM of each sacroiliac joint. RESULTS: A total number of 120 subchondral BME lesions (acute: 17, chronic active: 103) were noted. The mean ADC values of the BME lesions (1.30 ± 0.18 × 10(-3) mm(2)/s) were significantly higher than the ADC values in the NABM regions (0.55 ± 0.08 × 10(-3) mm(2)/s) as well as in both the control group (0.56 ± 0.05 × 10(-3) mm(2)/s) and the chronic inactive group (0.54 ± 0.03 × 10(-3) mm(2)/s). There were more BME regions in patients with chronic active sacroiliitis than early SpA patients. Correlation was found between the CRP values and ADC values. CONCLUSION: DWI with ADC values may be complementary to FS T2-weighted or STIR MR images for accurately diagnosing inflammatory sacroiliitis. The value of DWI versus dynamic contrast-enhanced imaging in the follow-up needs to be clarified.

Relationship of neutrophil-lymphocyte ratio with the presence, severity, and extent of coronary atherosclerosis detected by coronary computed tomography angiography.

We evaluated whether the neutrophil-lymphocyte ratio (NLR) was associated with the presence, severity, and extent of coronary atherosclerotic plaques detected by computed tomography angiography (CTA). We studied 238 patients who underwent dual-source 64-slice CTA for the assessment of coronary artery disease. Coronary arteries were evaluated on 16-segment basis and critical plaque was described as luminal narrowing >50%. In regression analysis, being in the third NLR tertile increased the risk of coronary atherosclerosis (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.15-4.43; P = .023). When the severity of coronary atherosclerosis was assessed, being in the third NLR tertile increased the risk of critical luminal stenosis (OR, 2.60; 95% CI, 1.19-5.69; P = .017). Although plaque morphology was not associated with NLR, the extent of coronary atherosclerosis was increased with higher NLR tertiles (P = .001). Our results suggest that a higher NLR may be a useful additional measure to assess cardiovascular risk in clinical practice.

Percutaneous treatment of huge congenital coronary-cameral fistula.

An 11-year-old girl was admitted to our hospital with a history of fatigue, effort dyspnea, and chest pain. On transthoracic echocardiography, the parasternal short-axis and apical four-chamber color Doppler flow imaging showed a structure matching the level of the coronary sinus and pouring into the right ventricle. On multi-slice computed tomography, the circumflex artery became immediately narrowed just before draining in to the base of the right ventricle, close to the septal leaflet of the tricuspid leaflet, and the Qp/Qs was 1.6. Congenital coronary-cameral fistula is an infrequent condition that establishes a direct link between coronary arteries and cardiac chambers. Although coronary artery fistulae are commonly asymptomatic, they may cause severe symptoms depending on the severity of the shunt, and may be treated medically, surgically or by transcatheter closure. In this case report, we present a patient with a huge circumflex artery-to-right ventricle fistula treated successfully with a duct occluder device.