Sung Gook Song

Step-and-shoot prospectively ECG-gated vs. retrospectively ECG-gated with tube current modulation coronary CT angiography using 128-slice MDCT patients with chest pain: diagnostic performance and radiation dose

Background With increasing awareness for radiation exposure, the study of diagnostic accuracy of coronary CT angiography (CCTA) with low radiation dose techniques is mandatory to both radiologist and clinician. Purpose To compare diagnostic performance and effective radiation dose between step-and-shoot prospectively ECG-gated and retrospectively ECG-gated with tube current modulation (TCM) CCTA using 128-slice multidetector computed tomography (MDCT). Material and Methods We retrospectively evaluated 60 patients who underwent CCTA with either of two different low-dose techniques using 128-slice MDCT (23 patients for step-and shoot-prospectively ECG-gated and 37 patients for retrospectively ECG-gated with TCM CCTA) followed by conventional coronary angiography. All coronary arteries and all segments thereof, except anatomical variants or small size (< 1.5 mm) ones, were included in analysis. Results In per-segment analysis, sensitivity, specificity, positive predictive value, and negative predictive value were 91/96%, 95/94%, 75/73%, and 98/99% for step-and-shoot prospectively ECG-gated and retrospectively ECG gated with TCM CCTA, respectively, relative to conventional coronary angiography. Effective radiation dose were 1.75 ± 0.83 mSv, 4.91 ± 1.71 mSv in the step-and-shoot prospectively ECG-gated and retrospectively ECG-gated with TCM CCTA groups, respectively. Conclusion The two low-radiation dose CCTA techniques using 128-slice MDCT yields comparable diagnostic performance for coronary artery disease in symptomatic patients with low heart rates.

Severe Aortic Coarctation in a 75-Year-Old Woman: Total Simultaneous Repair of Aortic Coarctation and Severe Aortic Stenosis

Aortic coarctation is usually diagnosed and repaired in childhood and early adulthood. Survival of a patient with an uncorrected coarctation to more than 70 years of age is extremely unusual, and management strategies for these cases remain controversial. We present a case of a 75-year-old woman who was first diagnosed with aortic coarctation and severe aortic valve stenosis 5 years ago and who underwent a successful one-stage repair involving valve replacement and insertion of an extra-anatomical bypass graft from the ascending to the descending aorta.

Hail in Silence! Mobile Thrombus in the Aortic Arch

A 41-year-old man was admitted to the emergency department for sudden-onset right hemiparesis. He had no history of diabetes mellitus, hypertension, arrhythmias, or stroke. However, he had a 20-year history of smoking, dyslipidemias, and hypothyroidism (laboratory test on admission revealed elevated thyrotropin [13.16 μIU/mL; reference, 0.27 to 4.2], normal T3 [0.84 ng/mL; reference, 0.58 to 1.59], and normal free T4 [0.81 ng/dL; reference, 0.70 to 1.48] levels). Magnetic resonance imaging of the brain revealed newly developed left cerebral infarction (Figure 1A and 1B). Brain computed tomographic (CT) perfusion imaging demonstrated perfusion defect in the left middle cerebral artery territory (Figure 1C), and CT angiography revealed total occlusion of the left internal carotid artery (Figure 1D). Chest radiography and …