Murat Vural

Evaluation of effective regurgitant orifice area of mitral valvular regurgitation by multislice cardiac computed tomography.

OBJECTIVE The purpose of our study was to assess the diagnostic accuracy of multislice computed tomography (MSCT) for the identification and quantification of mitral valve regurgitation in comparison with transthoracic echocardiography (TTE). METHODS Twenty-six patients (15 females, 11 males with a mean age of 44.6±14.1 years) who were in follow-up with the diagnosis of mitral regurgitation and those who were referred for MSCT were enrolled. MSCT results were compared with TTE measurements. RESULTS The mean effective mitral regurgitant orifice area at MSCT was 23.1±13.0 mm² and at echocardiography was 24.4±16.0 mm². Bland-Altman analysis showed good agreement between the two imaging methods. CONCLUSION MSCT provides reliable and good results for the evaluation of mitral regurgitation.

Assessment of global left ventricular systolic function with multidetector CT and 2D echocardiography: a comparison between reconstructions of 1-mm and 2-mm slice thickness at multidetector CT.

PURPOSE To compare multidetector computed tomography (MDCT) and two-dimensional transthoracic echocardiography (2DE) for left ventricular ejection fraction (EF); and to make comparison between reconstructions of 1-mm and 2-mm slice thickness at MDCT in left ventricular analysis by using a semiautomated segmentation algorithm. MATERIALS AND METHODS In 43 patients global left ventricular systolic function was assessed by using both MDCT and 2DE. Functional MDCT data sets were reconstructed in 20 cardiac phases (0-95%) with both 1-mm and 2-mm slice thickness.With semi-automatic left ventricle segmentation, end-diastolic volume (EDV), endsystolic volume (ESV) and EF were calculated seperately for both 1-mm and 2-mm reconstructions. RESULTS On MDCT with 1-mm slice thickness, mean EF was 66.8 +/- 5.6 %, mean EDV was 133.7 +/- 38.9 mL, and mean ESV was 45.1 +/- 17.9 mL, these values for 2-mm slice thickness were 66.2 +/- 5.6 %, 133.5 +/- 39.6 mL, and 45.9 +/- 18.3 mL, respectively. On 2DE, mean EF was 66.7 +/- 5.7 %, mean EDV was 98.7 +/- 42.1 mL, and mean ESV was 33.6 +/- 18.7 mL. There was no difference between EF values calculated with 1-mm and 2-mm reconstructions and 2DE (P = 0.83 and P = 0.3705, respectively). However, EDV and ESV values calculated by MDCT were significantly higher than those obtained by 2DE (P < 0.0001). CONCLUSION There was a good correlation between MDCT and 2DE in the evaluation of left ventricular EF. At MDCT left ventricular ESV was statistically smaller, EF was statistically greater by using 1-mm rather than 2-mm slice thickness. However, these differences are not clinically relevant.

The evaluation of the retrobulbar orbital fat tissue and optic nerve with strain ratio elastography

AIM The aim of this study was to evaluate the diagnostic performance of strain ratio elastography in the assessment of retrobulbar orbital fat tissue. MATERIALS AND METHODS The retrobulbar fat tissue of 14 eyes in 14 participants was scanned by sonoelastography. All the participants had permanent vision loss secondary to glaucoma in at least one eye. The elasticity scores were determined and the strain ratio was based on the comparison of the average strain measured in the retrobulbar fat tissue around the optic nerve at the same depth. RESULTS The mean strain values for the optic nerve (B) and the retrobulbar fat tissue (A) were 0.78+/-0.61 and 1.43+/-0.99, respectively (p=0.005). The mean strain ratio (B/A) was 0.56+/-0.24. CONCLUSION This preliminary study showed that by providing strain values and ratios of different orbital tissues sonoelastography may have a potential use in the diagnosis and follow-up of orbital inflammatory and infiltrative diseases.

Changes in the before and after thyroxine treatment levels of adipose tissue, leptin, and resistin in subclinical hypothyroid patients.

SummaryBackgroundSubclinical hypothyroidism (SH) occurs when serum thyroid stimulating hormone (TSH) concentrations are raised and serum thyroid hormone concentrations are normal. The effect of SH on the proinflammatory adipose cytokine releasing visceral adipose tissue (VAT) is not clear. The aim of this study is to identify the difference between the pre and posttreatment levels of VAT, leptin, and resistin in SH patients.MethodsThere were 51 SH patients and 43 age- and gender-matched healthy subjects included in the study. Thyroid functions, biochemical tests, leptin, resistin, and visceral and subcutaneous fat measurements were made. The measurements were repeated in the SH group in the third month following L-thyroxin treatment.ResultsInitially, high sensitivity C-reactive protein, carotid artery intima-media thickness (mm), leptin, and resistin levels were significantly higher in the SH group compared to the controls, while the other parameters were similar. While no correlation was observed between TSH levels and adipokines, a positive correlation was detected between waist circumference and leptin levels (r = 0.549, p < 0.01). Visceral adipose tissue was positively correlated to age, waist circumference, and leptin levels, but negatively correlated to free thyroxin (T4) levels (r = 0.419, p = 0.009; r = 0.794, p < 0.01; r = 0.515, p < 0.01 and r = − 0.416, p = 0.009, respectively). A significant decrease was observed in VAT volume, leptin, and resistin levels of SH patients following levothyroxine treatment. Conclusion The reduced VAT volume, leptin, and resistin levels in SH patients following treatment may support the idea that TSH affects adipose tissue functions.

Left Internal Carotid Artery Agenesis Associated with Basilar and Left Vertebral Artery Aneurysm

Agenesis of the internal carotid artery (ICA) is a rare congenital anomaly. Most of the patients are asymptomatic and it is usually discovered incidentally by computed tomography (CT) or magnetic resonance imaging (MRI). There is close association of the cranial aneurysms and subarachnoid hemorrhage with ICA agenesis. We present a case of a 61-year-old male with left ICA agenesis associated with basilar artery and left vertebral artery aneurysms. The patient complained of headaches and numbness on the right-side of the face. Physical examination showed high blood pressure (210/90 mmHg). Neurological examination revealed nystagmus and decreased sensation on the right-side of the face. Agenesis of left ICA, left carotid canal with basilar and left vertebral artery aneurysms were demonstrated incidentally using CT, MRI, and digital subtraction angiography, as a part of an evaluation for suspected cerebrovascular accident.

Multidetector computed tomographic anatomy of the coronary sinus in patients with supraventricular reentrant tachycardia

BACKGROUND In a number of previous studies it has been observed that coronary sinus (CS) ostium was larger and cannulation was easier in patients with atrioventricular nodal reentrant tachycardia (AVNRT). AIM To investigate the size and morphology of CS in AVNRT patients and compare them to those of atrioventricular reentrant tachycardia (AVRT) patients and a control group using multidetector computed tomography (MDCT), which is a non-invasive technique. METHODS Eighteen consecutive patients with AVNRT who were scheduled for catheter ablation in our institution constituted the study population. Sixteen patients with AVRT and 16 patients without supraventricular arrhythmia who underwent MDCT for other indications comprised the control group. A conventional transthoracic echocardiography was performed to all patients. The diameter of the CS at ostium as well as at 5, 10, and 15 mm inside the CS were measured on MDCT images. The CS was also categorised according to its morphology, as to whether it had a windsock shape or a tubular shape. RESULTS The AVNRT, AVRT and control groups were similar with regard to age, gender, body surface area and echocardiographic parameters. The size of the CS ostium was 10.9 ± 3.0, 11.1 ± 3.9 and 12.5 ± 3.6 mm for the AVNRT, AVRT and control groups, respectively (p = 0.393). There was no significant difference in the size of the CS from the ostium until 15 mm into the CS between the AVNRT, AVRT and control groups. The number of patients with windsock or tubular CS morphology were also similar between the three groups. CONCLUSIONS Contrary to previous reports, the CS size and morphology of patients with AVNRT did not differ from that of AVRT or control patients.

Multiple simultaneous venous and arterial thromboses in a patient with factor V Leiden disorder: Detection by multislice computed tomography.

Arterial thrombosis is extremely rare in patients with factor V Leiden (FVL) mutation. Recent advances in multislice computed tomography (MSCT) technology facilitated diagnosis of thromboembolic events accurately without delay. We report a patient with FVL mutation and acute bilateral lower extremity deep venous thromboses, pulmonary thromboembolism, and acute left anterior descending artery thrombosis, all diagnosed by MSCT. MSCT has been utilized for prompt diagnosis of the concomitant thrombotic pathologies simultaneously.

Relationship between retinopathy and asymptomatic atherosclerosis determined by measurement of carotid intima-media thickness in patients with type 2 diabetes mellitus

OBJECTIVE Presence of diabetic retinopathy (DR) may be used as an early marker of atherosclerosis in type 2 diabetes mellitus (DM) patients. This study aimed to investigate the relationship between the presence of DR and carotid intima-media thickness (CIMT), which is an indicator of early atherosclerosis in patients with type 2 DM. METHODS Thirty DM patients with retinopathy (DR group), 28 DM patients without retinopathy (non-DR group), and 27 healthy controls (control group) were included in the study. CIMT was assessed using a high-resolution B-mode ultrasonography device. RESULTS Mean CIMT was found to be 0.9±0.17 mm in the DR group, 0.8±0.16 mm in the non-DR group, and 0.7±0.13 mm in the control group. CIMT was found to be statistically significantly higher in the DR group compared to the other 2 groups (p<0.001). When multivariate analysis was performed, presence of DR still remained as an independent risk factor for increased CIMT values. CONCLUSION Presence of DR in type 2 DM patients is an independent risk factor in terms of increased CIMT, which is considered to be a finding of subclinical atherosclerosis. Therefore, we believe that type 2 DM patients with retinopathy should be closely followed in terms of cardiovascular events.