Deniz Akata

Evaluation of Coronary Artery Disease by Computed Tomography Angiography in Patients Treated for Childhood Hodgkin's Lymphoma

PURPOSE To detect pathologies in coronary arteries by computed tomography angiography (CTA) in survivors of childhood Hodgkins lymphoma who have been treated with radiotherapy and/or cardiotoxic agents. PATIENTS AND METHODS Patients with HL who have been in remission for at least 2 years after completion of therapy were included. CBC, lipid profile, urine analysis, brain natriuretic peptide, troponin-T, creatinine kinase-myocardial band, ECG, telecardiography, echocardiography, and CTA of the patients were performed. Cardiac vascular abnormalities were noted. Results A total of 119 patients were included in the study. In 19 patients (16%), we found coronary artery abnormalities. There was a significant difference between the patients who received mediastinal radiotherapy and those who did not (P = .02). By multivariate analysis, in patients receiving mediastinal radiotherapy the risk of developing a coronary artery abnormality was found to increase 6.8 times compared with patients who did not receive mediastinal radiotherapy (P = .009). Stent implantation was performed in a 28-year-old patient because of critical stenosis in right coronary. In two patients some irregularities were detected both in CTA and conventional angiography, and they remained in close follow-up. A 22-year-old patient whose CTA showed critical stenosis in his left anterior descending artery refused the conventional angiography. CONCLUSION To our knowledge, this is the first large study using CTA for detection of coronary abnormalities in patients treated for HL in pediatric age group. Coronary CTA is a minimally invasive tool for early diagnosis of coronary artery disease in patients who were treated with mediastinal radiotherapy and/or cardiotoxic chemotherapy.

Gallbladder duplication: imaging findings and differential considerations

Duplication of the gallbladder, a rare congenital anomaly, is important in clinical practice because it may cause some clinical, surgical, and diagnostic problems. We present imaging findings of a double gallbladder including coronal reformatted computed tomographic sections, to our knowledge not previously presented, and discuss the radiologic signs that may be helpful in diagnosis. We also present another case of a double gallbladder in which only one gallbladder was imaged 10 years after cholecystectomy.

Serum uric acid levels predict the severity and morphology of coronary atherosclerosis detected by multidetector computed tomography.

In this study, we aimed to evaluate whether serum uric acid (UA) was associated with the severity and morphology of coronary atherosclerotic plaques (CAP) shown by multidetector computed tomography (MDCT). The study population consisted of 982 patients (58% men) who underwent dual-source 64 slice MDCT for the assessment of coronary artery disease (CAD). Coronary arteries were evaluated on 16 segment basis and critical coronary plaque was described as luminal narrowing >50%, whereas plaque morphology was assessed on per segment basis. Serum UA levels were determined using commercially available assay kits. The critical atherosclerotic lesions were detected in 454/982 (46.2%) subjects by MDCT. Serum UA levels were found to be higher in patients with any coronary plaque (6.9 ± 1.5mg/dL vs. 5.1 ± 1.3mg/dL, p<0.01). Also UA level was higher in patients with critical stenosis compared to non-critical stenosis (6.1 ± 1.5mg/dL vs. 5.4 ± 1.3mg/dL, p<0.001). Subjects having primarily calcified plaques have higher UA levels compared to other plaque subtypes (5.5 ± 1.3 for non-calcified plaques, and 5.6 ± 1.2 for mixed plaques, 6.6 ± 1.6 for calcified plaques, p<0.001). This independent association was remained after multinominal regression analysis (OR: 1,987; 95% CI; 1.69-2.32; p<0.01). Our study demonstrated that serum UA level was significantly associated with the severity and the calcified morphology of CAP detected by MDCT. Further prospective clinical studies are needed to clarify the exact physiopathologic role of UA in CAD.

Plasma myeloperoxidase is related to the severity of coronary artery disease.

Objective — It has been shown that the main apolipoprotein of HDL, Apo A-1, is subjected to nitration by myeloperoxidase (MPO) and this oxidative modification renders HDL proatherogenic. The aim of this study is to evaluate the relationship between plasma MPO levels, and the severity of coronary artery disease. Methods and results — Forty-eight patients with coronary artery narrowing and 30 control subjects were enrolled in this study. The severity of the disease was assessed by Gensini scoring after angiography. MPO concentrations were determined by using an enzyme immunoassay. A subgroup of 30 patients underwent computerized tomography to determine the calcium load of coronary arteries. Plasma MPO levels were found significantly higher in patients with coronary artery disease than controls (4.27 [1.60 to 42.43] ng/mL vs. 2.93 [1.00 to 9.25] ng/mL, P = 0.002). MPO was positively correlated with both Gensini (r = 0.228, P = 0.044) and coronary calcium scores (r = 0.433, P = 0.017). The atherosclerotic burden was more strongly correlated with MPO levels than the traditional markers such as total cholesterol and HDL. Conclusions — We found that MPO levels were elevated in patients with coronary artery disease and this increase correlated with the extent and severity of atherosclerosis. Although it is a preliminary study with a relatively small group of subjects, we suggest that MPO might be evaluated as a new marker indicating the presence and severity of coronary artery disease.

CT findings of lymphoma with peritoneal, omental and mesenteric involvement: Peritoneal lymphomatosis

PURPOSE We aimed to describe computed tomography (CT) findings in patients with peritoneal, omental and mesenteric lymphoma involvement. MATERIALS AND METHODS We searched our archive retrospectively to find out patients with peritoneal, omental and mesenteric lymphoma involvement. We found 16 patients with non-Hodgkin lymphoma meeting these criteria. CT studies of these patients were reevaluated for the presence of peritoneal involvement, ascites, omental mass, organomegaly, retroperitoneal lymphadenopathy, bowel wall thickening and other associated findings. RESULTS There were 14 males and 2 females with peritoneal and/or mesenteric and omental lymphoma involvement. Mean age was 39 (range 4-76). Subgroups of non-Hodgkin lymphoma were diffuse large B-cell lymphoma (n=11), small cell lymphocytic lymphoma (n=2), small cleaved cell lymphoma (n=1), T-cell lymphoma (n=1) and Burkitts lymphoma (n=1). Peritoneal involvement was seen in 15 patients (93.8%) in the form of linear (n=12) and nodular (n=3) thickening. Ascites was seen in 12 (75%) patients. Omental and mesenteric masses were present in 10 (66.6%) and 10 (66.6%) patients, respectively. Bowel wall thickening, retroperitoneal lymphadenopathy and hepatosplenomegaly were also common and observed in 10, 10 and 11 patients, respectively. Solid organ involvement in the form of liver and splenic lesions was seen in 9 (56%) patients. CONCLUSION Peritoneal involvement can be seen in many subtypes of lymphoma and most frequently in diffuse large B-cell lymphoma. Peritoneal lymphomatosis can mimic peritoneal carcinomatosis and should be included in the differential diagnosis list in patients with ascites, hepatosplenic lesions and unidentified cause of peritoneal thickening on CT in a male patient.

US and CT Findings in the Diagnosis of Tuberculous Peritonitis

Purpose: To evaluate the ultrasonographic and CT findings of tuberculous peritonitis. Material and Methods: Ultrasonographic and CT findings of 11 patients with the ascitic type of tuberculous peritonitis were reviewed. Results: All patients had ascites, and ultrasonography (US) demonstrated fine complete and incomplete mobile septations in 10 patients. In 5 of them, the ascites had a lattice-like appearance. Diffuse regular peritoneal thickening was detected in all patients by CT and in 10 patients by US. CT demonstrated infiltration of the greater omentum in 9 patients, whereas US showed omental thickening in only 5 patients. Conclusion: Peritoneal and omental thickening detected by CT and ascites with fine, mobile septations shown by US strongly suggest the ascitic type of tuberculous peritonitis. The 2 imaging modalities should be used together for accurate diagnosis of tuberculous peritonitis.

CT and MRI findings of sclerosing angiomatoid nodular transformation of the spleen: spoke wheel pattern.

Sclerosing angiomatoid nodular transformation of the spleen is a recently described benign pathologic entity that is characterized by round shaped vascular spaces that are lined by endothelial cells, and the spaces are circumscribed by granulomatoid structures. Microscopically, all the reported cases had multiple angiomatoid nodules in a fibrosclerotic stroma. Each angiomatoid nodule was made up of slit-like, round or irregular shaped vascular spaces that were lined by endothelial cells and interspersed ovoid cells. We present here the CT and dynamic gadolinium-enhanced MR findings of a patient with sclerosing angiomatoid nodular transformation. The spoke-wheel pattern that was observed on MRI in this case may be an important imaging clue for making the correct diagnosis of this benign lesion.

Giant benign cystic peritoneal mesothelioma: US, CT,and MRI findings

Abstract Benign cystic peritoneal mesothelioma (BCPM) is a rare tumor, primarily affecting young women; approximately 130 cases have been described mainly in the pathological and surgical literature. We present imaging findings of a giant BCPM in a male patient and discuss the radiological differential diagnosis with a brief review of the literature.

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.

Percutaneous treatment of an orbital hydatid cyst: a new therapeutic approach

PURPOSE To describe the percutaneous treatment of an orbital hydatid cyst as an alternative approach to conventional surgery. METHODS In a 21-year-old man with diplopia and right proptosis, radiologic studies disclosed a 25 x 25 x 20-mm purely cystic mass in the right retrobulbar area. Based on the presumptive diagnosis of hydatid cyst, the cyst was treated percutaneously under ultrasonographic guidance with aspiration, 15% hypertonic saline injection, and reaspiration without any complication. RESULTS A substantial decrease in the size of the cyst was observed in the 3 months after treatment. Nine months after treatment, the shrunken cyst had a volume of only 0.5 ml, and the patient was asymptomatic. Twenty-one months after the procedure, the findings were consistent with those at 9 months of follow-up. CONCLUSION Percutaneous treatment of orbital hydatid cysts, which is more satisfactory to both the patient and the physician, may be a safe and effective alternative to surgical extirpation.