Percutaneous Treatment of Splenic Cystic Echinococcosis: Results of 12 Cases.

PURPOSE: Cystic echinococcosis (CE) in the spleen is a rare disease even in endemic regions. The aim of this study was to examine the efficacy of percutaneous treatment for splenic CE. MATERIALS AND METHODS: Twelve patients (four men, eight women) with splenic CE were included in this study. For percutaneous treatment, CE1 and CE3A splenic hydatid cysts were treated with either the PAIR (puncture, aspiration, injection, respiration) technique or the catheterization technique. RESULTS: Eight of the hydatid cysts were treated with the PAIR technique and four were treated with catheterization. The volume of all cysts decreased significantly during the follow-up period. No complication occurred in seven of 12 patients. Abscess developed in four patients. Two patients underwent splenectomy due to cavity infection developed after percutaneous treatment, while the spleen was preserved in 10 of 12 patients. Total hospital stay was between 1 and 18 days. Hospital stay was longer and the rate of infection was higher in the catheterization group. Follow-up period was 5-117 months (mean, 44.8 months), with no recurrence observed. CONCLUSION: The advantages of the percutaneous treatment are its minimal invasive nature, short hospitalization duration, and its ability to preserve splenic tissue and function. As the catheterization technique is associated with higher abscess risk, we suggest that the PAIR procedure should be the first percutaneous treatment option for splenic CE.

Myocardial bridging as evaluated by 16 row MDCT.

PURPOSE: The purpose of this study is to find out the prevalence, appearance and clinical symptoms of myocardial bridging (MB) by MDCT coronary angiography (CTA). MATERIALS AND METHODS: A total of 280 (50 females) consecutive patients followed with coronary artery disease or postoperative stent and bypass control, underwent CTA performed by 16-MDCT scanner between January 2006 and April 2006. Short axis multiplanar reformatted images were evaluated. MBs were classified as complete and incomplete bridges with respect to continuity of the myocardium over the tunneled segment of left anterior descending artery (LAD) in interventricular groove and the cut-off value is 1.3mm. Patients diagnosed with MB on CTA who had prior catheter angiography studies were re-evaluated for the presence of MB. RESULTS: One hundred and twenty MBs [98 (81.6%) on LAD, 2 (1.6%) on diagonal branch, 11 (9.1%) on obtuse marginal, 4 (3.3%) on right coronary artery, 5 (4.1%) on ramus intermedius artery] were detected in 108 (38.5%) patients. Eighty-five (70.8%) of bridged segments in 79 (28.2%) patients were complete and the rest [35 (29.2%) in 34 (12.1%) patients] were incomplete. In 12 patients two MBs (either on different arteries or on the same artery) were detected. The length of bridged segments in patients with complete and incomplete MBs varied between 4-50.9mm (mean 18mm) and 4-37.3mm (mean 13.6mm), respectively, and the depth of myocardium over the artery ranged between 1-6.4mm (mean 2.3mm) and 1-1.2mm (mean 1mm), respectively. Thirty (27.7%) out of 108 patients, in whom MB was detected on CTA, were found to have correlative catheter angiography studies, retrospectively and MB was detected only in 4 (13.3%) out of 30 patients. CONCLUSION: MDCT coronary angiography is a non-invasive, efficient method in the diagnosis of MB avoiding the procedural risks that catheter angiography carries. MDCT coronary angiography allows direct visualization of the bridge itself and may thus give the opportunity to differentiate between complete and incomplete myocardial bridges.

Intercoccygeal angle and type of coccyx in asymptomatic patients.

PURPOSE: To assess the intercoccygeal angle of asymptomatic patients (without coccydynia), to study if there is a difference of angle between types of coccyx and between genders with the same type of coccyx. MATERIALS AND METHODS: Ninety-two patients (42 females, 50 males, range of ages 8-86, mean 50) who underwent computed tomography (CT) angiography and colonoscopy were included in the study. CT images with slice thickness of 1 or 1.5 mm were evaluated with 3D sagittal reformats and intercoccygeal angle, type of coccyx were examined. RESULTS: Twenty-one females and 18 males had type 1 coccyx with mean intercoccygeal angle 36.4 degrees +/- 10.56 (33.29 degrees for females and 40.05 degrees for males) and the difference of the angles between genders is statistically significant (P = 0.044). Among 36 patients (14 were females and 22 were males) with type 2 coccyx demonstrated mean intercoccygeal angle of 56.36 degrees +/- 10.8. 15 patients were shown to have type 3 coccyx and the mean intercoccygeal angle was 72.1 degrees +/- 31.86. No significant difference of angles was seen between genders. Type 4 coccyx was not seen and two coccyx could not be classified. There was a significant difference of intercoccygeal angle between the groups overall. CONCLUSION: Type 1 is the most common coccyx type in asymptomatic patients. Significant difference of intercoccygeal angle was defined between the types of coccyx. These values may be reference for the patients underwent surgery for the coccydynia and a new classification may be needed since exceptional shape of coccyx exists that could not be defined according to the known classification.

Imaging characteristics of Takayasu arteritis.

Takayasu arteritis is a rare, large-vessel vasculitis in which the nonspecific systemic inflammatory symptoms are followed by inflammation of the aorta and its major branches. The inflammation of this vessel leads to progressive luminal stenosis or aneurysm formation resulting in limb or organ ischemia. Although conventional angiography is still accepted as the gold standard modality, the information obtained is limited to the vessel lumen. Multidetector computed tomographic angiography and magnetic resonance angiography can provide valuable information not only regarding intraluminal pathologies but also concerning the thickening of the vessel wall, which may be the earliest manifestation of the disease.

Comparison of short and long axis methods in cardiac MR imaging and echocardiography for left ventricular function.

PURPOSE: The purpose of this study was to compare long axis and short axis methods in cardiac magnetic resonance imaging (MRI), and echocardiography for the evaluation of left ventricular function and mass. MATERIALS AND METHODS: The study included 15 patients with a history of myocardial infarction and 5 patients with normal ventricular function who were examined with cardiac MRI and echocardiography. Left ventricular function and mass analyses calculated with Simpson's method from short axis images were compared to the results of horizontal long axis, vertical long axis, and combined axes methods. In addition, results obtained from echocardiography were compared to the short axis method in cardiac MRI. RESULTS: In the patient group, there was no significant difference between ejection fraction calculated by modified Simpson's analysis in echocardiography and short axis imaging in cardiac MRI. In cardiac MRI, there was significant difference between ejection fractions assessed from both horizontal and vertical long axis images, and those assessed from short axis images. There was no significant difference in both patient and control groups between end-diastolic volume determined from short axis and end-diastolic volume determined by horizontal long axis, vertical long axis, and combined long axes. Significant difference between the patient and control groups was observed in end-diastolic volume calculated by modified Simpson's echocardiographic method. CONCLUSION: The present study demonstrated that there were no significant advantages of simplified MRI techniques over modified Simpson's method echocardiography. Therefore, patients who cannot be evaluated by echocardiography optimally should be evaluated by short axis cine MRI sequence.

Myocardial bridging on MDCT.

OBJECTIVE: The aim of this study is to show the usefulness of MDCT in the diagnosis of myocardial bridging. Although most of the time myocardial bridging is a benign condition, it may be associated with myocardial ischemia and secondary complications. Therefore, it is important to be able diagnose the presence of myocardial bridging. CONCLUSION: MDCT is an effective noninvasive method for the diagnosis of myocardial bridging because MDCT can show the length and the depth of the tunneled artery and the diameter and percentage of stenosis in the segments showing myocardial bridging in the systolic and diastolic phases. Moreover, MDCT is efficient in showing the presence of other coronary artery, myocardial, epicardial, and neighboring thoracic abnormalities.