Ayaz Aghayev

The Rate of Resolution of Clot Burden Measured by Pulmonary CT Angiography in Patients With Acute Pulmonary Embolism

OBJECTIVE The purpose of this article is to quantitatively assess the rate of resolution of clot burden detected on pulmonary CT angiography (CTA) in patients with acute pulmonary embolism (PE). MATERIALS AND METHODS We evaluated 111 consecutive patients (55 men and 56 women) in a retrospective cohort who were diagnosed with PE by pulmonary CTA and had at least one follow-up pulmonary CTA within 1 year. Two radiologists in consensus measured the volume of each clot using a semiautomated quantification program. Semiquantitative measures of clot burden were also computed. The resolution rates of the total clot volume, as well as clot volumes of the central (main and lobar) and peripheral vessels (segmental and subsegmental), were analyzed. RESULTS The mean (± SD) clot volume per study was 3403.3 ± 6505.6 mm(3) at baseline and 531.6 ± 2383.5 mm(3) at the follow-up pulmonary CTA. Overall, 85 patients (77% ) showed complete resolution at the follow-up pulmonary CTA. Complete resolution was seen in 17 of 30 patients (56.7%) at a follow-up interval of 1-14 days, in 24 of 31 patients (77.4%) at 29-90 days, and in 32 of 34 patients (94.1%) after 90 days. The total clot volume measurements summed for all patients decreased by 78% (central clot, 69.4%; peripheral clot, 86.0%) at 14 days, by 96.6% (central clot, 93.4%; peripheral clot, 100%) at 90 days, and by 97.7% (central clot, 95.9%; peripheral clot, 100%) after 90 days. CONCLUSION Clot burden resolved completely in 77% of patients during the follow-up period. Our analysis showed that clots resolved faster in the peripheral arteries than in the central pulmonary arteries.

Recent developments in the use of computed tomography scanners in coronary artery imaging

ABSTRACT Introduction: Within the past decade, substantial evolution of Coronary CT Angiography (CCTA) has affected evaluation and management of coronary artery disease. In particular, technical advancement of hardware technology and image reconstruction of CT scanners have played an important role in this context making it possible to acquire abundant data with excellent temporal and spatial resolution within a shorter scan time. In addition, a concern related to the high radiation exposure in the initial noninvasive coronary artery imaging has triggered improvement in dose reduction techniques. Areas covered: In this review article, we have focused on recent technological developments in CT scanners and the impact of these developments on CCTA parameters. Expert Commentary: CCTA plays an important role in coronary artery disease management, and technical development of the CT scanners can be expected to address and remedy technical limitations.

Estimation of single‐kidney glomerular filtration rate without exogenous contrast agent

Measurement of single‐kidney filtration fraction and glomerular filtration rate (GFR) without exogenous contrast is clinically important to assess renal function and pathophysiology, especially for patients with comprised renal function. The objective of this study is to develop a novel MR‐based tool for noninvasive quantification of renal function using conventional MR arterial spin labeling water as endogenous tracer.

Hepatic steatosis in diabetic patients does not predict adverse liver-related or cardiovascular outcomes.

Steatosis is a defining feature of nonalcoholic fatty liver disease (NAFLD). However, evidence that severity of steatosis can predict adverse outcomes in NAFLD or nonalcoholic steatohepatitis (NASH) is lacking. The aim of this study was to determine whether steatosis assessed by computed tomography (CT) imaging predicts adverse outcomes in diabetic patients at risk for NAFLD/NASH.

IgG4-Related Disease With Coronary Arteritis

A 53-year-old male patient with chronic renal failure and biopsy-proven Immunoglobulin G4 (IgG4) renal involvement presented with complains of chest pain and syncope. An ECG showed lateral ST segment depressions concerning for myocardial ischemia. The patient underwent coronary catheterization, which revealed multifocal aneurysms and severe stenosis. A cardiac computerized tomographic angiogram was performed to further characterize aneurysms, which showed aneurysms involving left main, proximal left anterior descending artery, and proximal right coronary artery (Figures 1 and 2). Circumferential mural thickening with associated enhancement of the wall of the coronary arteries, particularly at the site of the stenoses, was concerning for vasculitis. A small pulmonary artery aneurysm was seen in the right upper lobe (Figure 3 …

Cross-sectional imaging of aortic infections

AbstractAortic infections are uncommon clinical entities, but are associated with high rates of morbidity and mortality. In this review, we focus on the cross-sectional imaging appearance of aortic infections, including aortic valve endocarditis, pyogenic aortitis, mycotic aneurysm and aortic graft infections, with an emphasis on CT, MRI and PET/CT appearance. Teaching Points • Aortic infections are associated with high morbidity and mortality. • CT, MRI and FDG PET/CT play complementary roles in aortic infection imaging. • Radiologists should be vigilant for aortic infection manifestations to ensure timely diagnosis.

The use of cryoablation in treating liver tumors

Percutaneous image-guided tumor ablation techniques have been used as an alternative method for patients with unresectable liver tumors. Although all techniques avoid morbidity and mortality of major surgery and have advantage of preserving non-tumoral liver parenchyma, cryoablation currently is the only percutaneous ablation technique allowing intraprocedural monitoring because of visibility of its ablation effect with computed tomography and MRI. Cryoablation uses extremely low temperatures to induce local tissue necrosis to treat both primary and metastatic liver tumors. This article discusses the principles of liver tumor percutaneous cryoablation, including mechanisms of tissue injury, technique, equipment, image-guidance used, patient selection criteria, clinical outcome and complications as well as current trends and future goals.

Spontaneous thrombosis of uterine artery pseudoaneurysm: Follow‐up with doppler ultrasonography and interventional management

Iatrogenic uterine arterial injury is one of the possible causes of pseudoaneurysm formation occurring during pelvic or obstetrical surgery. Cesarean delivery is the commonest cause. Repeat vaginal bleeding is the most frequent symptom, but fever and lower abdominal pain have also been reported. Doppler sonography (US) has been used to detect a pelvic pseudoaneurysm. Transcatheter arterial embolization of the uterine artery is a highly effective, relatively minimally invasive method for treating such condition. A 21-year-old primigravida was admitted to our hospital with a history of repeated vaginal bleeding following a Cesarean section that she underwent 2 months earlier. Transvaginal color Doppler US (TV-CDUS) examination showed a 14 mm 12 mm pseudoaneurysm arising from the left uterine artery at the isthmic level. The pseudoaneurysm was located in the myometrium and had a thin, peripheral rim-like thrombosis (Figure 1). Catheter angiography performed 2 days later did not reveal filling of the pseudoaneurysm, and there was no extravasation of contrast. TV-CDUS immediately after angiography revealed a spontaneous total thrombosis of the pseudoaneurysm (Figure 2). The patient was clinically stable and vaginal bleeding had ceased for 36 hours. Because most of the pseudoaneurysm had thrombosed spontaneously and there was no angiographic finding, conservative management was recommended. On follow-up TV-CDUS 2 days later, a complete thrombosis of the pseudoaneurysm was observed but, 1 day later, the patient was readmitted with vaginal bleeding. Taking into account a possible hemorrhage from the other probably injured uterine artery (which could be occult on angiography and could also be due to rebleeding of the thrombosed pseudoaneurysm), transarterial embolization of both uterine arteries with gelfoam was undertaken. The patient has not suffered from any vaginal bleeding after the embolization. A pseudoaneurysm of the uterine artery is a rare complication of pelvic surgery but may result in life-threatening complications such as massive vaginal hemorrhage. In general, pseudoaneurysms are thrombosed in a centripetal manner (from the periphery to the center) like in our case. CDUS can elegantly demonstrate the sequence of steps leading to the complete thrombosis of the pseudoaneurysm. In some circumstances, a pseudoaneurysm cannot be demonstrated on angiography. Transarterial embolization of the uterine arteries is a safe and effective means of controlling secondary postpartum hemorrhage. In our case, according to TV-CDUS findings, the pseudoaneurysm completely thrombosed in a short period of time, and angiography was negative. We could not exclude hemorrhage from the contralateral uterine artery (which may have been injured during previous surgery), so bilateral uterine arteries were embolized. In conclusion, a spontaneous thrombosis of a uterine artery pseudoaneurysm can occur. TVCDUS provides sufficient information to detect and follow-up the progress of the thrombosis.

Use of Cardiac Computerized Tomography to Predict Neo–Left Ventricular Outflow Tract Obstruction Before Transcatheter Mitral Valve Replacement

Although the incidence of mitral stenosis has declined precipitously in the Western world due to the reduced incidence of rheumatic heart disease, mitral regurgitation remains one of the most common valvular pathologies.[1][1] Many patients affected by severe mitral valve disease are elderly with

State-of-the-art Magnetic Resonance Imaging in Vascular Thoracic Outlet Syndrome.

Vascular thoracic outlet syndrome is caused by compression of subclavian/axillary vessels during their passage from the thoracic cavity to the axilla. Early diagnosis and treatment is important to prevent debilitating outcomes of vascular thoracic outlet syndrome. Contrast-enhanced three-dimensional (3D) magnetic resonance angiography (MRA) with equilibrium phase using provocative arm positioning is the optimal examination to determine presence, degree of vascular compression, and complications of vascular thoracic outlet syndrome. This article reviews thoracic outlet anatomy, disorders of the vascular component, and typical imaging findings by contrast-enhanced 3D MRA.