Abstract:

Introduction: all over the world, the number of patients with peripheral arterial lesions is growing, the progression of the disease leads to the chronic limb-threatening ischemia (CLTI) with an increasement in mortality. To carry out revascularization, it is required to accurately determine the degree and length of lesions of arteries of limbs, with the creation of a «road map» of lesions and the choice of the least affected artery ? the target arterial pathway.

Aim: was to determine the effectiveness of CT angiography in diagnosing lesions of shin arteries in patients with critical lower limb ischemia (CLI) by calculating its sensitivity and specificity in comparison with digital subtraction angiography.

Materials and methods: the study included 26 patients (15 men and 11 women, average age of patients 69,3 ± 10,8 years) with critical lower limb ischemia, against the background of lesions of the femoro-popliteal segment of arteries, class D TASC II. All patients underwent CT angiography on a 64-spiral computed tomography scanner. Obtained data was compared with results of catheter angiography (digital subtraction angiography), used as a reference method.

Results: the sensitivity of CT angiography in determining the degree of lesion (stenosis or occlusion) of leg arteries was 100% and 94%, the specificity was 83% and 96%, respectively. The overall accuracy of CT angiography in the tibial segment was 87% for stenoses and 94% for occlusions. According to results of CTA, massive calcification was detected in 13% of cases from the total number of analyzed arteries. When evaluating these arteries according to DSA data, most of arteries (11 of 12) were occluded, and the length of occlusions in 8 cases was maximum according to the GLASS classification (the length was more than 1/3 of the artery length). The presence of strong correlations between CT angiography and digital angiography on the presence of occlusions, stenoses> 50% and their length was determined.

Conclusions: CT angiography is a highly informative method for diagnosing the degree and length of lesions of shin arteries in patients with critical lower limb ischemia.

References

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Abstract

Article provides a literature review on problems of diagnosing of intracranial aneurysms (IA) rupture and its complications.

Aim: was to study relevant data on the use of computed tomography (CT), as well as other imaging methods, in patients with ruptured aneurysms in the acute period.

Materials and methods: a search was conducted for publications on this topic, dating up to December 2019, using main Internet resources: PubMed databases, scientific electronic library (Elibrary), Scopus, ScienceDirect, Google Scholar.

Results: we analyzed 45 literature sources, covering the period from 1993 to 2019, which include 3 meta-analyzes, 5 descriptions of studies evaluating the effectiveness of various visualization methods for ruptured IA. Both foreign and Russian publications were involved.

Conclusion: native CT is the leading visualization method to detect hemorrhages in nearest hours after the rupture of IA. CT angiography in combination with digital subtraction angiography (DSA), according to the vast majority of authors, allows to make thorough preoperative planning in the shortest time, as well as to identify unruptured aneurysms. Based on the obtained data, it is advisable to conduct a study to assess the role of CT in the acute period of IA rupture, as well as in the diagnosis of complications in the early postoperative period.

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Abstract

Aim: was to determine the role of radiation and interventional methods of diagnosis and treatment of traumatic pelvic bleeding.

Material and methods: for the period 2016 -2019, we analyzed results of diagnosis and treatment of 37 patients with pelvic injuries, complicated by intra-pelvic bleeding. CT scanning of retroperitoneal pelvic hematoma (RPH) was performed in all cases, results of calculations were compared with the surgical classification of I.Z. Kozlova (1988) on the spread of retroperitoneal hemorrhage and volume of blood loss in pelvic fractures. MSCT-A was performed in 16 (45%) injured. Digital subtraction angiography (DSA) was performed in 10 (27%) cases, of which after MSCT-A – in 4 cases, and as the primary method for the diagnosis of arterial bleeding – in 6 cases.

Results: according to MSCT, the frequency of minor hemorrhages was 18 (50%), medium 16 (43%), large 3 (8%). CT calculation of the volume of small hemorrhages ranged from 92 to 541 cm3, medium – 477-1147 cm3, large –1534 cm3 and more. MSCT-A revealed signs of damage of arteries of the pelvic cavity: extravasation of contrast medium – in 4, cliff and «stop-contrast» – in 1, post-traumatic false aneurysm – in 1, displacement and compression of the vascular bundle – in 4 observations. DSA revealed signs of damage of vessels of the pelvis: extravasation of contrast medium – 3, angiospasm – 2 and occlusion – 2 observations. According to results of angiography, embolization of damaged arteries was performed in 5 observations.

Conclusion: MSCT is a highly sensitive method in assessing the distribution and calculation of RPH volume. The presence of a hematoma volume of more than 50-100 cm3, regardless of the type of pelvic damage, was an indication for MSCT. In patients with stable hemodynamics, DSA was used as a clarifying diagnostic method; in patients with unstable hemodynamics, it was used as the main method for diagnosis and treatment of injuries of pelvic vessels. Damage of pelvic vessels detected by angiography was observed predominantly in unstable pelvic fractures, accompanied by medium and large retroperitoneal pelvic hemorrhages.

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Abstract:

Background: clinical case of a rarely encountered pathology (0.1-3.5%) in cardiac surgery, such as the aneurysm of the left coronary artery (LCA), is presented. It was detected and analyzed by coronary angiography and coronary CT angiography

Aim: was to show possibilities of radiation research methods in identifying and evaluating of coronary artery aneurysms.

Materials and methods: a 67-year-old patient was referred to the Federation National Center of Cardiovascular Surgery (Penza) for follow-up examination (coronary angiography) and to decide on the choice of management due to the presence of critical aortic valve stenosis. Performed coronary angiography and subsequent coronary CT angiography for demonstrate the topography of the aneurysm.

Results: according to the data of coronary angiography at the region of trifurcation of the LCA or the anterior descending artery, intermediate and circumflex arteries a large-sized aneurysm is visualized. Due to coronary CT angiography data, the one is located at a distance of 1.0 cm from the entrance of the LCA in the area of trifurcation. It's presented by an aneurysmal dilatation of a rounded shape 1.3 cm in diameter with locally calcific walls.

Conclusion: coronary angiography and coronary CT angiography made it possible to identify anc examine individual morphological features of the anatomy of the coronary artery aneurysm, as well as demonstrate and take apart its topography to clearly, which in turn made it possible to rationally determine the management of the patient.

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Abstract:

Recently one can see higher incidence rate of fatty liver. The purpose of our study was to examine the abilities of raiodiagnostics (computed tomography and bolus contrast-enhanced CT angiography) in patients with different stages of non-alcoholic hepatic steatosis. Seventy four patients with morphologically verified diagnosis of non-alcoholic hepatic steatosis were included into the study. Hepatic parenchyma density was assessed quantitatively, as well as blood flow parameters at time-dencity curve in stages 1 (initial), 2 (moderate), and 3 (severe) of the disease. It was shown that hepatic time-dencity curve in patients with fatty liver was lower than splenic one. Thus, computed tomography and CT angiography are highly informative methods in diagnostics of hepatic steatosis, defying not only presence of the disease, but differentiating its stage and optimizing the therapeutic strategy.

References 

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