S. Uhlig

Logistic regression model for identification of right ventricular dysfunction in patients with acute pulmonary embolism by means of computed tomography

PURPOSE Diagnosis of right ventricular dysfunction in patients with acute pulmonary embolism (PE) is known to be associated with increased risk of mortality. The aim of the study was to calculate a logistic regression model for reliable identification of right ventricular dysfunction (RVD) in patients diagnosed with computed tomography pulmonary angiography. MATERIAL AND METHODS Ninety-seven consecutive patients with acute pulmonary embolism were divided into groups with and without RVD basing upon echocardiographic measurement of pulmonary artery systolic pressure (PASP). PE severity was graded with the pulmonary obstruction score. CT measurements of heart chambers and mediastinal vessels were performed; position of interventricular septum and presence of contrast reflux into the inferior vena cava were also recorded. The logistic regression model was prepared by means of stepwise logistic regression. RESULTS Among the used parameters, the final model consisted of pulmonary obstruction score, short axis diameter of right ventricle and diameter of inferior vena cava. The calculated model is characterized by 79% sensitivity and 81% specificity, and its performance was significantly better than single CT-based measurements. CONCLUSION Logistic regression model identifies RVD significantly better, than single CT-based measurements.

Evaluation of aortic contractility based on analysis of CT images of the heart

The paper presents a method to assess the aortic contractility based on the analysis of CT images of the heart. This is an alternative method that can be used for patients who cannot be examined by using echocardiography. Usage of medical imaging application for DICOM file processing allows to evaluate the aortic cross section during systole and diastole. It makes possible to assess the level of aortic contractility.

Persistent trigeminal artery as a rare cause of ischaemic lesion and migraine-like headache.

The persistent trigeminal artery (PTA) is a rare remnant of the embryonic intracranial circulatory system that forms a carotid-vertebrobasilar anastomosis. In most cases PTA does not have clear clinical implications. However, some authors report the association of PTA occurrence with vertigo, dizziness and nerve palsy, resulting in diplopia, strabismus or trigeminal neuralgia in patients. In rare cases it may also be related to posterior cerebral circulation strokes. This work reports the case of a female patient who presented with migraine-like headache and an ischaemic lesion in the left temporal lobe in association with PTA.

Volumetric reconstruction of the right ventricle improves reproducibility of interventricular septum bowing in patients with pulmonary embolism

Bowing of the interventricular septum (IVS) is a sign of severe pulmonary embolism(PE); however, it is affected by high interobserver variability. The aim of the study was to evaluate the application of volumetric reconstructions of the right ventricle for assessment of IVS position regarding its accuracy in identifying right ventricular dysfunction, as well as interobserver agreement in evaluating this sign.IVS bowing was evaluated with multiplanar reformations (MPR) and volumetric reconstruction (VR, volume rendering) by 2 observers. The accuracy of IVS bowing sign was better for VR-based assessment; however, it was not significantly better than the MPR-based evaluation. Interobserver agreement was found to be fair (kappa = 0.381) for the MPR-based grading of IVS position as normal orabnormal, while it was significantly better for the VR method (kappa = 0.629,p < 0.001). The VR-based method may improve utilisation of IVS bowing sign inpatients with PE.

Congenital Anomalies of Thoracic Systemic and Pulmonary Veins Visualized with Computed Tomography

Introduction of multidetector computed tomography (MDCT) into daily clinical use has been a breakthrough in the thoracic imaging. It allowed one breathhold scanning of the entire chest, and thin sections made multiplanar and volumetric reconstructions easily available. Initially, the main interest focused on the abdominal aorta and its branches, however, it turned out, that MDCT allows for an excellent visualization and assessment of thoracic veins, including their anatomical variants and thrombosis. Thin collimation combined with secondary reconstructions allows preliminary diagnosis of vascular anomalies even in precontrast scanning. Secondary reconstructions in oblique or curved planes, three-dimensional reconstructions and ECG-gating allow clear identification of venous pathologies.