Can Özkaynak

Renal colic: comparison of spiral CT, US and IVU in the detection of ureteral calculi

The aim of our study was to compare noncontrast spiral CT, US and intravenous urography (IVU) in the evaluation of patients with renal colic for the diagnosis of ureteral calculi. During a period of 17 months, 112 patients with renal colic were examined with spiral CT, US and IVU. Fifteen patients were lost to follow-up and excluded. The remaining 97 patients were defined to be either true positive or negative for ureterolithiasis based on the follow-up data. Sensitivity, specificity, positive and negative predictive value and accuracy of spiral CT, US and IVU were determined, and secondary signs of ureteral stones and other pathologies causing renal colic detected with these modalities were noted. Of 97 patients, 64 were confirmed to have ureteral calculi based on stone recovery or urological interventions. Thirty-three patients were proved not to have ureteral calculi based on failure to recover a stone and diagnoses unrelated to ureterolithiasis. Spiral CT was found to be the best modality for depicting ureteral stones with a sensitivity of 94 % and a specificity of 97 %. For US and IVU, these figures were 19, 97, 52, and 94 %, respectively. Spiral CT is superior to US and IVU in the demonstration of ureteral calculi in patients with renal colic, but because of its high cost, higher radiation dose and high workload, it should be reserved for cases where US and IVU do not show the cause of symptoms.

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

IntroductionWe 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 methodsSequentially 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 ≥50%, respectively. CTP abnormality was noted using cerebral blood flow and volume and mean transit time maps.ResultsOf 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.ConclusionIn SAH patients, if there is a macrovascular vasospasm with luminal narrowing ≥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.

Absence of the azygos vein.

A rare case of the absence of the azygos vein (AV) is presented. Imaging findings on plain chest film and on contrast-enhanced spiral computed tomography (CT) are described, and embryology of azygos and hemiazygos veins (HV) is reviewed. On PA chest radiographs, both the absence of AV shadow on its usual location and the presence of the aortic nipple may consider agenesis of AV, and this anomaly can be easily confirmed by CT.

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.

Absence of the azygos vein associated with double superior vena cava--a case report.

A rare case of absence of the azygos vein associated with double superior vena cava is presented. Imaging findings on plain chest film and on contrast-enhanced computed tomography are described, and the embryology of azygos and hemiazygos veins is reviewed.

Aneurysmal bone cyst of metacarpal

expansile lesion which comprises 1% of all bone tumors [1]. Its occurrence in metacarpals is extremely rare. To our knowledge, only eight cases have been reported, none of them in the radiologic literature; the most recent one was diagnosed in 1988 and reported with only plain film findings [2]. We present this case of aneurysmal bone cyst located in a metacarpal with plain film, computerized tomography, and digital subtraction angiography images.

Percutaneous sclerotherapy of a symptomatic simple renal cyst in a child: observation of membrane detachment sign

A 6-year-old girl with 21 sy mptomatic renal cyst underwent successful percutaneous aspiration and sclerotherapy with hypertnic saline under US guidance. Although membrane detachment sign was seen clearly during aspira tion, it was confirmed to he a simple cyst. In contrast to prey ious reports, membrane detachment sign is not pathognomonic for hydatid and may be seen after simple cyst aspiraion. Therefore differntiation of a symptomatic renal cyst from a hydatid cyst should not depend solely on membrane detachmentIn either case US- or CT-guided percutatneous sclerotherapy should always be considered before surgery.

Schwachman-diamond syndrome: A case report

Schwachman-Diamond syndrome is an autosomal recessive disorder consisting of exocrine pancreatic insufficiency and neutropenia. The typical pathological finding with this syndrome is fatty infiltration in the pancreas of patients. We report a case of Scwachman-Diamond syndrome examined with abdominal ultrasonography, CT and radiography.

Intrapulmonary right brachiocephalic vein associated with azygos lobe

A rare case of right brachiocephalic vein (RBV) following an extramediastinal and intrapulmonary course in the anterior portion of the azygos fissure is presented. The appearance of the RBV and superior vena cava (SVC) on the chest radiograph in patients with an azygos lobe reflects the variable relationship between these veins and their mediastinal attachments. Computed tomography (CT) can easily demonstrate the mediastinal vascular anatomy thereby allowing identification of such variants and differentiation from anomalous pulmonary veins draining into the systemic vein.

Lung Cancer Detection with Low-Dose Spiral Computed Tomography in Chronic Obstructive Pulmonary Disease Patients

Purpose: To determine whether low-dose spiral computed tomography (LDCT) can improve the lung cancer detection rate in chronic obstructive pulmonary disease (COPD) subjects. Material and Methods: From October 1999 to December 2003, 374 COPD patients underwent LDCT for lung carcinoma screening. All subjects with an abnormal baseline CT scan were followed with serial CT scans as part of our protocol. Follow-up was continued until the demonstration of no change over a minimum of 24 months, or resolution. Sputum samples were also obtained for cytological analysis. Results: On the baseline spiral CT scan, 132 of 374 patients (35.2%) had at least one non-calcified nodule that required periodic follow-up with CT scans. The median follow-up time was 21 months (range 2–48 months). Of the 374 COPD subjects, nine patients with primary lung cancer (2.4%) were detected: six were squamous cell carcinomas, two were small-cell lung carcinomas (SCLC), and one was adenosquamous carcinoma. Three of the nine tumors were in stage IA, two in stage IIB, two in stage IIIA, and two were limited SCLC. Potentially curative pulmonary resection was performed in four patients, pulmonary lobectomy in three, and wedge excision in one. One subject with stage IA squamous cell carcinoma received radiotherapy, as pulmonary function was severely impaired. In addition, four patients underwent removal of benign lesions. Sputum was collected in 205 (54.8%) of 374 patients. There were 154 (75 %) metaplasia, 14 (6%) moderate dysplasia, and one (0.4%) malignant case. Conclusion: LDCT increases early lung carcinoma detection rate in COPD patients, but pulmonary function impairment may reduce its benefit.