Leukoaraiosis and carotid artery stenosis: evaluation with CT angiography.

OBJECTIVE: We aim to determine the relationship between leukoaraiosis and carotid artery stenosis. METHODS: Carotid-cerebral multislice computed tomography angiographies of 194 patients (mean age, 63.5 years) were retrospectively evaluated. Presence and severity of leukoaraiosis and carotid artery stenosis were compared to each other. Carotid artery stenosis was defined by the criteria of the North American Symptomatic Carotid Endarterectomy Trial; leukoaraiosis was evaluated based on the European Task Force on Age-Related White Matter Changes criteria. RESULTS: The frequency of leukoaraiosis was 52%. The correlations between age and presence and severity of leukoaraiosis as well as the degree of carotid artery stenosis were significant. There was a significant relationship between the presence of leukoaraiosis and carotid artery stenosis; also, a positive correlation was found between the severity of the leukoaraiosis and the degree of carotid artery stenosis. CONCLUSIONS: Leukoaraiosis is more common among the elderly. Significant relationship between the severity of leukoaraiosis and the degree of carotid artery stenosis points out that leukoaraiosis may be an advanced stage of atherosclerosis.

Evaluation of myocardial fat deposition by multislice computed tomography.

AIM: To investigate correlations between myocardial fat deposition of unknown etiology and myocardial infarction, coronary artery stenosis, time after the infarction, aneurysmatic dilatation of arteries, and stenting or bypass operation. PATIENTS AND METHODS: We evaluated coronary computed tomography angiographies of 266 patients presenting with history of myocardial infarction or having risk factors for coronary artery disease, analyzed the characteristics of myocardial fat, and compared the clinical parameters of patients with and without myocardial fat. RESULTS: 34 of the 266 patients had myocardial fat deposits. Of the 34 with myocardial fat, 47% had a history of myocardial infarction. Myocardial fat occurrence after myocardial infarction was statistically significant. Myocardial fat was more frequently associated with longer time after infarction and fewer coronary arteries involved, but without statistical significance. A bypass operation and myocardial fat deposition correlated with aneurysmatic dilatation of the coronary arteries and myocardial fat deposition within the area supplied by this artery. CONCLUSION: Myocardial fat was detected in 34% of patients with myocardial infarction. Myocardial fat was significantly more frequent in patients who underwent a bypass operation and those who had aneurysmatic dilatation of the coronary arteries. The frequency of myocardial fat deposition increased with the involvement of fewer coronary arteries and longer time after infarction.

CT angiography and perfusion imaging in patients with subarachnoid hemorrhage: correlation of vasospasm to perfusion abnormality.

INTRODUCTION: We retrospectively evaluated computed tomography angiography (CTA) and perfusion imaging (CTP) of patients with aneurysmal subarachnoid hemorrhage (SAH) for any correlation between degree of vasospasm and perfusion deficit. MATERIALS AND METHODS: Sequentially performed CTP and CTA of 41 patients at least at the third day of postbleeding were reviewed for vasospasm and perfusion deficit throughout the anterior and middle cerebral arteries and corresponding territories. Vasospasm was noted comparing the contralateral normal ones or extradural components of the vessel itself and graded to negative, mild, moderate, and severe as luminal narrowing none, <25%, between 25% and 50%, and >or=50%, respectively. CTP abnormality was noted using cerebral blood flow and volume and mean transit time maps. RESULTS: Of 41 patients, 20 had no vasospasm; 15 had mild to moderate and six had severe vasospasm. Three of 20 patients with no vasospasm (15%), four of 15 patients with mild to moderate vasospasm (26%), and five of six patients with severe vasospasm (83%) had perfusion abnormality. Perfusion abnormalities noted were ischemia, infarction, and hyperperfusion. Perfusion abnormality without vasospasm was observed in the watershed areas and adjacent to sulcal clots. CONCLUSION: In SAH patients, if there is a macrovascular vasospasm with luminal narrowing >or=50%, there is a high likelihood (83%) of perfusion abnormality in the territory of the vasospastic vessel. There may also be perfusion abnormality without macrovascular vasospasm in the watershed areas or in the vicinity of sulcal clots.

Right top pulmonary vein: evaluation with 64 section multidetector computed tomography.

PURPOSE: To evaluate the incidence and anatomic features of the rare variant of the pulmonary veins named "right top pulmonary vein" as depicted with 64 section multidetector computed tomography (MDCT). MATERIALS AND METHODS: MDCT of 610 patients obtained over 12 months period for diagnosis of suspected thoracic or cardiac pathology were routinely reviewed in transverse and 3D images. The frequency of right top pulmonary vein (RTPV) was determined and anatomic features were also documented. RESULTS: Right top pulmonary vein (RTPV) is a supernumerary vein arising from the roof of the right part of the left atrium separately from the orifice of the right superior pulmonary vein. It crosses behind the intermediate bronchus and drains mainly posterior segment of the right upper lobe but also receives few subsegmental branches of superior segment of the right lower lobe. It was detected in 2.2% of patients (14/610). The mean diameter of RTPV was 5.1 mm. CONCLUSION: The RTPV is a rare venous drainage variation of pulmonary veins. It is important to be aware of this anatomic pattern for avoiding misinterpretation of pulmonary venographic findings, inadvertent ablation of pulmonary vein and perioperative bleeding during video assisted thorocoscopic lobectomy.

Hepatic epithelioid hemangioendothelioma treated with orthotopic liver transplantation: a case report.

Hepatic epithelioid hemangiendothelioma is a rare vascular tumor. The clinical course is unpredictable and different treatment modalities are offered depending on the patients condition. Orthotopic liver tranplantation is the choice of treatment in diffuse cases without metastases. A 32 year old woman was admitted to hospital with multiple mass lesions diagnosed by ultrasonography of the liver. Physical examination was normal except for a painless hepatomegaly, and her biochemical tests were within the normal range. Computed tomographic scanning showed the presence of multiple lesions in both lobes, some of which were accompanied by a small degree of calcification. Although these findings were suggestive of hepatic epithelioid hemangioendothelioma, ultrasonographic guided fine needle aspiration biopsy failed to diagnose the exact nature of the lesions. The diagnosis of hepatic epithelioid hemangioendothelioma was confirmed by diagnostic laparotomy and immunohistochemical examination of the specimen by FVIII-RAg, CD34 and CD 31 markers. The patient was treated by orthotopic liver transplantation and had no evidence of tumor 18 months after transplantation. The problems in differential diagnosis and treatment options are discussed in this report of the first case of this rare tumor, treated by orthotopic liver transplantation in Turkey.