Vieussens' arterial ring: a rare coronary variant anatomy.

PURPOSE: We aimed to evaluate Vieussens' arterial ring (VAR) variants by consecutive coronary computed tomography (CT) angiography examinations. METHODS: We retrospectively evaluated the presence of VAR in a total of 3443 consecutive coronary CT angiography examinations performed between November 2010 and January 2015. CT examinations were performed with a 64-row multidetector computed tomography (MDCT) scanner. All CT angiography images were evaluated for the presence and morphologic features of VAR subtypes. VAR variants were classified into four subgroups. RESULTS: Eleven VAR variations (3.19‰) were identified. Type 1A was the most common VAR type (n=8), followed by Type 2 (n=2) and Type 3 (n=1). Type 1B was not detected. CONCLUSION: Although VAR variation is less frequently detected with coronary CT angiography than in previously reported anatomic series, coronary CT angiography is quite effective to reveal VAR subtypes and other relevant cardiocoronary anomalies.

Choosing the appropriate side for subcutaneous port catheter placement in patients with mastectomy: ipsilateral or contralateral?

PURPOSE: To evaluate long-term clinical follow-up results of implanting subcutaneous port catheters (SPCs) on ipsilateral or contralateral with mastectomy side in patients with axillary lymph node dissection. METHODS: A total of 73 patients composed of ipsilateral (34 catheters) and contralateral (39 catheters) groups, with SPCs were included. All patients had lumpectomy or modified radical mastectomy for breast cancer. Ipsilateral and contralateral groups had similar patient characteristics. RESULTS: Five late complications were seen in the ipsilateral group and 2 late complications in the contralateral group. No statistical significant difference was seen between two groups in regard to late complications. Four complications of the ipsilateral group were classified as major group C and 1 as major group D, while 1 complication of the contralateral group was classified as minor group B and 1 as major group C according to Society of Interventional Radiology (SIR) classification. No statistical significant difference was seen between complication rates of two groups in regard to SIR classification. CONCLUSIONS: SPC related complications do not differ in regard to ipsilateral or contralateral side selection on mastectomized patients with breast cancer and lymph node dissection. SPCs can be implanted on ipsilateral or contralateral sides of the operation in these patients.

Safety and functionality of transhepatic hemodialysis catheters in chronic hemodialysis patients.

PURPOSE: We aimed to investigate the safety and functionality of tunneled transhepatic hemodialysis catheters in chronic hemodialysis patients. METHODS: Thirty-eight patients (20 women aged 56±10 years and 18 men aged 61±11 years) with transhepatic tunneled hemodialysis catheters were evaluated. The date of the first transhepatic catheterization, indications, procedure details, functional time periods of catheters, reasons for the removal or revision of catheters, catheter-related complications, and current conditions of patients were retrospectively analyzed. RESULTS: A total of 69 catheters were properly placed in all patients (100% technical success) under imaging guidance during the 91-month follow-up period. The functionality of 35 catheters could not be evaluated: five catheters were removed because of noncomplication related reasons (surgical fistulas were opened in two cases [2/35, 5.7%], transplantation was performed in three cases [3/35, 8.6%]), 18 patients died while their catheters were functional (18/35, 51.4%), and 12 catheters were still functional at the time of the study (12/35, 34.3%). The functionality of catheters was evaluated the remaining 34 catheters that necessitated revision because of complications. Furthermore, only half of the catheters were functional on day 136 when evaluated using Kaplan-Meier analysis. The four main complications were thrombosis (16/34, 47%; complication rate of 0.37 days in 100 catheters), infection (8/34, 23.5%; 0.18 days in 100 catheters), migration (8/34, 23.5%; 0.18 days in 100 catheters), and kinking (2/34, 6%; 0.04 days in 100 catheters). CONCLUSION: Transhepatic venous catheterization is a safe and functional alternative route in chronic hemodialysis patients without an accessible central venou route. The procedure can be performed with high technical success and low complication rates under imaging guidance.

Low radiation dose computed tomography coronary angiography: evaluation of the variations in coronary arteries.

OBJECTIVE: Despite attempts to decrease the radiation dose, coronary computed tomography angiography (CCTA) generally uses higher doses than computed tomography scans of other organs. The purpose of this study was to evaluate the incidence of the variations of the coronary arteries using the adaptive statistical iterative reconstruction technique to perform low-dose coronary computed tomography (CTA). METHODS: Diagnostic CCTA scans were performed in 3433 patients (from November 2010 to January 2015) using an Optima CT660 (GE Healthcare, USA) 64-slice and analyzed retrospectively. RESULTS: The mean effective dose was 2.1 mSv (1.2-4.9 mSv) for prospective and 4.5 mSv (3.6-9.1 mSv) for retrospective ECG-gated scans. The variations of the coronary arteries (CA) excluding myocardial bridge (MB) were detected in 76 (2.2 %) of the 3433 patients. A myocardial bridge was the most common variation (n = 288, 8.3 %). The second most common variation (n = 13, 17.1 %) was an absence of the left main coronary artery (LMCA) with separate starting points for the left anterior descending (LAD) and left circumflex (LCX) arteries. In addition, there was a rare variation (n = 1, 1.3 %) consisting of the LAD artery originating from the right coronary artery (RCA). CONCLUSIONS: The present retrospective study was conducted using CCTA on patients with a coronary artery variations in Turkey (n = 3433). Our data show that low-dose CCTA can be used to detect common coronary variations.

Arteriovenous fistula between descending aorta and left inferior pulmonary vein: Closure with vascular plugs.

Echocardiography revealed systemic artery to pulmonary venous fistula, a rare vascular anomaly, in a 20-month-old girl, and multislice computed tomography angiography (CTA) was performed to rule out congenital heart disease. Normal bronchial connection and pulmonary vasculature were observed in the lung. The fistula drained through the left inferior pulmonary vein to the left atrium leading to a left-to-left shunt. Percutaneous intervention was performed in 2 stages using Amplatzer vascular plugs to close successfully.

Radiological report: expectations of clinicians.

PURPOSE: Although there have been many publications on composing an accurate radiological report, they usually do not include an assessment of the clinicians' expectations from a radiological report. In this study, we aimed to assess the clinicians' expectations and preferences in terms of radiology report style and content. MATERIALS AND METHODS: A multiple-choice questionnaire, containing 19 questions, was formed. Two-hundreds clinicians, working either in a university hospital or a public hospital, were allocated into 4 groups which included equal number of clinicians from surgery and internal medicine departments. Questionnaire was applied to participants by face-to-face interview. Results were analyzed for each group using Pearson chi-square test. RESULTS: No statistically significant difference was found among four groups except for the 16th question which was about the image format pertaining to the report (CD/DVD or negative film). It has been determined that clinicians preferred detailed, standardized radiological reports with complete sections (i.e., clinical information, technique, findings, conclusion, recommendations). CONCLUSION: This study provided essential data for radiologists to write more effective reports.