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Radiation dose and diagnostic image quality associated with iterative reconstruction in coronary CT angiography: A systematic review

Abdullah KA, McEntee MF, Reed W, Kench PL

J Med Imaging Radiat Oncol, 2016 Aug;60(4):459-68.
PMID: 27241506 DOI: 10.1111/1754-9485.12473

The aim of this systematic review is to evaluate the radiation dose reduction achieved using iterative reconstruction (IR) compared to filtered back projection (FBP) in coronary CT angiography (CCTA) and assess the impact on diagnostic image quality. A systematic search of seven electronic databases was performed to identify all studies using a developed keywords strategy. A total of 14 studies met the criteria and were included in a review analysis. The results showed that there was a significant reduction in radiation dose when using IR compared to FBP (P 0.05). The mean ± SD difference of image noise, signal-noise ratio (SNR) and contrast-noise ratio (CNR) were 1.05 ± 1.29 HU, 0.88 ± 0.56 and 0.63 ± 1.83 respectively. The mean ± SD percentages of overall image quality scores were 71.79 ± 12.29% (FBP) and 67.31 ± 22.96% (IR). The mean ± SD percentages of coronary segment analysis were 95.43 ± 2.57% (FBP) and 97.19 ± 2.62% (IR). In conclusion, this review analysis shows that CCTA with the use of IR leads to a significant reduction in radiation dose as compared to the use of FBP. Diagnostic image quality of IR at reduced dose (30-41%) is comparable to FBP at standard dose in the diagnosis of CAD.

Matched MeSH terms: Coronary Angiography/methods*; Computed Tomography Angiography/methods*
ATRA-induced cerebral sinus thrombosis

Lee KR, Subrayan V, Win MM, Fadhilah Mohamad N, Patel D

J Thromb Thrombolysis, 2014 Jul;38(1):87-9.
PMID: 24046068 DOI: 10.1007/s11239-013-0988-7

All-trans retinoic acid (ATRA) and Idarubicin are part of the AIDA protocol employed for the treatment of Acute promyelocytic leaukaemia (APML) and has been associated with marked improvement in the prognosis. However, it is known to worsen the haematological picture during the course of induction of therapy. Herein, we present a case of an APML patient who developed a rare documented incidence of cerebral sinus thrombosis, first noticed as an ophthalmology referral. This 22 year old lady, a known APML patient was then started on chemotherapy based on AIDA protocol but 17 days into the initiation of therapy, she began to complain of blurred vision on the right eye. Anterior segments were normal but both fundi showed papilloedema with peripapillary haemorrhages. A contrast MRI that was then ordered showed multiple filling defects in numerous venous sinuses. She was started on anticoagulant treatment and the findings resolved. Though a rare case of its side-effects, ATRA usage in APML has a multitude of presentations since its primary pathology lies in the inherent pro-coagulant potential.

Matched MeSH terms: Cerebral Angiography*; Magnetic Resonance Angiography*
Fulltext Superselective embolisation for control of intractable epistaxis from maxillary artery injury

Singam P, Thanabalan J, Mohammed Z

Biomed Imaging Interv J, 2011 01 01;7(1):e3.
PMID: 21655112 MyJurnal DOI: 10.2349/biij.7.1.e3

Traumatic intractable epistaxis following fractures of the facial and base of skull rarely may be life-threatening. Common sites of injury are the internal carotid and maxillary artery. When conventional methods of arresting haemorrhage fail, the choices are then an open arterial ligation or superselective embolisation. This paper presents a patient with life-threatening epistaxis from a Le Fort type II fracture. Angiography revealed a maxillary artery injury in which superselective embolisation was performed and the haemorrhage was successfully arrested. A literature review of this technique is discussed, including its advantages and the relationship of the internal maxillary artery to facial fractures.

Matched MeSH terms: Angiography
Fulltext A Review of Medical Doppler Ultrasonography of Blood Flow in General and Especially in Common Carotid Artery

Oglat AA, Matjafri MZ, Suardi N, Oqlat MA, Abdelrahman MA, Oqlat AA

J Med Ultrasound, 2018 03 28;26(1):3-13.
PMID: 30065507 DOI: 10.4103/JMU.JMU_11_17

Medical Doppler ultrasound is usually utilized in the clinical adjusting to evaluate and estimate blood flow in both the major (large) and the minor (tiny) vessels of the body. The normal and abnormal sign waveforms can be shown by spectral Doppler technique. The sign waveform is individual to each vessel. Thus, it is significant for the operator and the clinicians to understand the normal and abnormal diagnostic in a spectral Doppler show. The aim of this review is to explain the physical principles behind the medical Doppler ultrasound, also, to use some of the mathematical formulas utilized in the medical Doppler ultrasound examination. Furthermore, we discussed the color and spectral flow model of Doppler ultrasound. Finally, we explained spectral Doppler sign waveforms to show both the normal and abnormal signs waveforms that are individual to the common carotid artery, because these signs are important for both the radiologist and sonographer to perceive both the normal and abnormal in a spectral Doppler show.

Matched MeSH terms: Angiography
Fulltext Thoracic aortic aneurysm (TAA) –a diagnostic dilemma in a patient with haemoptysis

Li, S.W., Osman, M.

Malaysian Journal of Emergency Medicine, 2017;2(1):23-27.
MyJurnal

This case illustrates the difficulty in diagnosing TAA from an uncommon symptom of haemoptysis, especially in a patient with recent cardiac eventandthe possibility of having a lung malignancy as he is anex-smoker. It appears that CT Angiography is the modality of choice here.

Matched MeSH terms: Computed Tomography Angiography
CT coronary angiogram in children with Kawasaki patients: experience in 52 patients

Borhanuddin BK, Abdul Latiff H, Mohamed Yusof AK

Cardiol Young, 2022 Dec;32(12):1994-1998.
PMID: 35707919 DOI: 10.1017/S1047951122000154

BACKGROUND: CT is an accepted non-invasive imaging tool to assess the coronary arteries in adults; however, its utilisation in children is limited by high heart rate and lack of standardised protocol. We sought to assess diagnostic quality and factors that affect image quality of CT in assessing coronary artery lesions in Kawasaki patients less than 18 years of age.
METHODOLOGY: CT coronary angiography was performed on patients with Kawasaki disease diagnosed with coronary aneurysm or suspected to have coronary stenosis. Studies were performed using electrocardiogram-gated protocols. General anaesthesia was used in patients who were not cooperative for breathing control. Heart rate, image quality, and effective radiation dose were documented.
RESULTS: Fifty-two Kawasaki patients underwent CT coronary angiography to assess coronary artery lesions. Median heart rate was 88 beats per minute (range 50-165 beats/minute). Image quality was graded as excellent in 34 (65%) patients, good in 17 (32%), satisfactory in 1, and poor in 1 patient. Coronary artery aneurysm was found in 25 (bilateral = 6, unilateral = 19, multiple = 11). Thrombus was found in 11 patients resulting in partial and total occlusion in 8 and 3 patients, respectively. Coronary stenosis was noted in 2 patients. The effective radiation dose was 1.296 millisievert (median 0.81 millisievert). Better diagnostic imaging quality was significantly related to lower heart rate (p = 0.007).
CONCLUSION: Electrocardiogram-triggered CT coronary angiography provides a good diagnostic assessment of coronary artery lesions in children with Kawasaki disease.

Matched MeSH terms: Coronary Angiography/methods; Computed Tomography Angiography/methods
Ductus arteriosus morphology in duct-dependent pulmonary circulation: CT classification and pattern in different ventricular morphology

Abdul Latiff H, Gopal AR, Hidayat ZF, Haranal M, Borhanuddin BK, Alwi M, et al.

Cardiol Young, 2023 Nov;33(11):2243-2251.
PMID: 36651340 DOI: 10.1017/S1047951122004218

BACKGROUND: The objective was to study the ductus arteriosus morphology in duct-dependent pulmonary circulation and its pattern in different ventricle morphology using CT angiography.
METHOD: From January 2013 to December 2015, patients aged 6 months and below with duct-dependent pulmonary circulation underwent CT angiography to delineate the ductus arteriosus origin, tortuosity, site of insertion, and pulmonary artery anatomy. The ductus arteriosus were classified into type I, IIa, IIb, and III based on its site of origin, either from descending aorta, distal arch, proximal arch, or subclavian artery, respectively.
RESULTS: A total of 114 patients and 116 ductus arteriosus (two had bilateral ductus arteriosus) were analysed. Type I, IIa, IIb, and III ductus arteriosus were seen in 13 (11.2 %), 71 (61.2%), 21 (18.1%), and 11 (9.5%), respectively. Tortuous ductus arteriosus was found in 38 (32.7%), which was commonly seen in single ventricular lesions. Ipsilateral and bilateral branch pulmonary artery stenosis was seen in 68 (59.6%) and 6 (5.3%) patients, respectively. The majority of patients with pulmonary atresia intact ventricular septum had type I (54.4%) and non-tortuous ductus arteriosus, while those with single and biventricular lesions had type II ductus arteriosus (84.9% and 89.7%, respectively). Type III ductus arteriosus was more common in biventricular lesions (77.8%).
CONCLUSIONS: Ductus arteriosus in duct-dependent pulmonary circulation has a diverse morphology with a distinct origin and tortuosity pattern in different types of ventricular morphology. CT may serve as an important tool in case selection and pre-procedural planning for ductal stenting.

Matched MeSH terms: Computed Tomography Angiography
Fulltext Automatic identification of hypertension and assessment of its secondary effects using artificial intelligence: A systematic review (2013-2023)

Gudigar A, Kadri NA, Raghavendra U, Samanth J, Maithri M, Inamdar MA, et al.

Comput Biol Med, 2024 Apr;172:108207.
PMID: 38489986 DOI: 10.1016/j.compbiomed.2024.108207

Artificial Intelligence (AI) techniques are increasingly used in computer-aided diagnostic tools in medicine. These techniques can also help to identify Hypertension (HTN) in its early stage, as it is a global health issue. Automated HTN detection uses socio-demographic, clinical data, and physiological signals. Additionally, signs of secondary HTN can also be identified using various imaging modalities. This systematic review examines related work on automated HTN detection. We identify datasets, techniques, and classifiers used to develop AI models from clinical data, physiological signals, and fused data (a combination of both). Image-based models for assessing secondary HTN are also reviewed. The majority of the studies have primarily utilized single-modality approaches, such as biological signals (e.g., electrocardiography, photoplethysmography), and medical imaging (e.g., magnetic resonance angiography, ultrasound). Surprisingly, only a small portion of the studies (22 out of 122) utilized a multi-modal fusion approach combining data from different sources. Even fewer investigated integrating clinical data, physiological signals, and medical imaging to understand the intricate relationships between these factors. Future research directions are discussed that could build better healthcare systems for early HTN detection through more integrated modeling of multi-modal data sources.

Matched MeSH terms: Magnetic Resonance Angiography
Fulltext Evaluation of an integrated 3D-printed phantom for coronary CT angiography using iterative reconstruction algorithm

Abdullah KA, McEntee MF, Reed W, Kench PL

J Med Radiat Sci, 2020 Sep;67(3):170-176.
PMID: 32219989 DOI: 10.1002/jmrs.387

INTRODUCTION: 3D-printed imaging phantoms are now increasingly available and used for computed tomography (CT) dose optimisation study and image quality analysis. The aim of this study was to evaluate the integrated 3D-printed cardiac insert phantom when evaluating iterative reconstruction (IR) algorithm in coronary CT angiography (CCTA) protocols.
METHODS: The 3D-printed cardiac insert phantom was positioned into a chest phantom and scanned with a 16-slice CT scanner. Acquisitions were performed with CCTA protocols using 120 kVp at four different tube currents, 300, 200, 100 and 50 mA (protocols A, B, C and D, respectively). The image data sets were reconstructed with a filtered back projection (FBP) and three different IR algorithm strengths. The image quality metrics of image noise, signal-noise ratio (SNR) and contrast-noise ratio (CNR) were calculated for each protocol.
RESULTS: Decrease in dose levels has significantly increased the image noise, compared to FBP of protocol A (P

Matched MeSH terms: Coronary Angiography*; Computed Tomography Angiography*
Impact of vessel volume on thermodilution measurements in patients with coronary microvascular dysfunction

Sakai K, Storozhenko T, Mizukami T, Ohashi H, Bouisset F, Tajima A, et al.

Catheter Cardiovasc Interv, 2024 May;103(6):885-896.
PMID: 38566527 DOI: 10.1002/ccd.31020

BACKGROUND: Two invasive methods are available to estimate microvascular resistance: bolus and continuous thermodilution. Comparative studies have revealed a lack of concordance between measurements of microvascular resistance obtained through these techniques.
AIMS: This study aimed to examine the influence of vessel volume on bolus thermodilution measurements.
METHODS: We prospectively included patients with angina with non-obstructive coronary arteries (ANOCA) undergoing bolus and continuous thermodilution assessments. All patients underwent coronary CT angiography to extract vessel volume. Coronary microvascular dysfunction was defined as coronary flow reserve (CFR)

Matched MeSH terms: Coronary Angiography*; Computed Tomography Angiography*
Fulltext Scalp arteriovenous malformation : a case report

Mohamed WN, Abdullah NN, Muda AS

Malays J Med Sci, 2008 Jul;15(3):55-7.
PMID: 22570590 MyJurnal

We report a rare case of Arteriovenous malformation (AVM) of the scalp in a 30 year-old Malay gentleman who presented with painless forehead swelling since birth. Magnetic Resonance Imaging (MRI) and cerebral angiogram performed and the findings are discussed.

Matched MeSH terms: Angiography
Diabetic retinopathy: a quadtree based blood vessel detection algorithm using RGB components in fundus images

Reza AW, Eswaran C, Hati S

J Med Syst, 2008 Apr;32(2):147-55.
PMID: 18461818

Blood vessel detection in retinal images is a fundamental step for feature extraction and interpretation of image content. This paper proposes a novel computational paradigm for detection of blood vessels in fundus images based on RGB components and quadtree decomposition. The proposed algorithm employs median filtering, quadtree decomposition, post filtration of detected edges, and morphological reconstruction on retinal images. The application of preprocessing algorithm helps in enhancing the image to make it better fit for the subsequent analysis and it is a vital phase before decomposing the image. Quadtree decomposition provides information on the different types of blocks and intensities of the pixels within the blocks. The post filtration and morphological reconstruction assist in filling the edges of the blood vessels and removing the false alarms and unwanted objects from the background, while restoring the original shape of the connected vessels. The proposed method which makes use of the three color components (RGB) is tested on various images of publicly available database. The results are compared with those obtained by other known methods as well as with the results obtained by using the proposed method with the green color component only. It is shown that the proposed method can yield true positive fraction values as high as 0.77, which are comparable to or somewhat higher than the results obtained by other known methods. It is also shown that the effect of noise can be reduced if the proposed method is implemented using only the green color component.

Matched MeSH terms: Fluorescein Angiography*
Magnetic resonance angiographic demonstration of carotid-cavernous fistula using elliptical centric time resolved imaging of contrast kinetics (EC-TRICKS)

Vattoth S, Cherian J, Pandey T

Magn Reson Imaging, 2007 Oct;25(8):1227-31.
PMID: 17442526

Magnetic resonance angiographic evaluation of the intracranial vasculature has been predominantly carried out using conventional angiographic techniques such as time of flight and phase contrast sequences. These techniques have good spatial resolution but lack temporal resolution. Newer faster angiographic techniques have been developed to circumvent this limitation. Elliptical centric time-resolved imaging of contrast kinetics (EC-TRICKS) is one such technique which has combined the use of elliptical centric ordering of the k-space with multiphase 3D digital subtraction MR angiogram (MRA) to achieve excellent temporal resolution of the arterial and venous circulations. Its applications have been mainly in the peripheral vasculature. We report the use of this technique in a case of a high-flow, direct carotid-cavernous fistula to demonstrate its potential in intracranial MR angiography.

Matched MeSH terms: Magnetic Resonance Angiography/methods*
Takayasu arteritis in major rheumatology centers in Malaysia

Khor CG, Tan BE, Kan SL, Tsang EE, Lim AL, Chong EY, et al.

J Clin Rheumatol, 2016 Jun;22(4):194-7.
PMID: 27219306 DOI: 10.1097/RHU.0000000000000362

OBJECTIVE: There is paucity of data for Takayasu arteritis (TAK) among South Asians. We aimed to evaluate the clinical features, angiographic findings, as well as treatment and outcome of TAK among Malaysian multiethnic groups.

METHODS: This is a retrospective review of 40 patients with TAK seen in major rheumatology centres in Malaysia between April 2006 and September 2013.

RESULTS: Majority were female patients (92.5%), with a female-to-male ratio of 12:1. Median duration of disease from diagnosis was 66 months (interquartile range, 33-177 months). Fifteen (37.5%) were Malays, 9 (22.5%) each were Indians and indigenous from East Malaysia and 7 (17.5%) were Chinese. Indian and indigenous from East Malaysia were overrepresented in this disease. The mean (SD) age of symptom onset and diagnosis were 25.5 (8.1) and 27.4 (8.4), respectively. The 3 most common clinical presentations at diagnosis were diminished or absent pulse, which occurred in 80% of the patients, followed by blood pressure discrepancy (60%) and arterial bruit (52.5%). There was no difference in clinical presentation among ethnic groups. The subclavian artery was the commonest vessel involved (72.5%), followed by the carotid artery (65%) and renal artery (47.5%). Eight patients had coronary artery involvement, and 2 patients had pulmonary artery involvement. Type I arterial involvement was the commonest (80.0%), followed by type IV (35%), present in isolation or mixed type. Glucocorticoid was the main medical treatment (90.0%). Nineteen patients (47.5%) underwent revascularization procedures. Five patients died during the follow-up period.

CONCLUSIONS: The Malaysian TAK cohort had similarities with and differences from other published TAK cohort. A nationwide TAK registry is needed to determine the prevalence of the disease among different ethnic groups.

Matched MeSH terms: Angiography/methods
Fulltext Establishment of CTPA Local Diagnostic Reference Levels with Noise Magnitude as a Quality Indicator in a Tertiary Care Hospital

Harun HH, Abdul Karim MK, Abd Rahman MA, Abdul Razak HR, Che Isa IN, Harun F

Diagnostics (Basel), 2020 Sep 09;10(9).
PMID: 32916913 DOI: 10.3390/diagnostics10090680

This study aimed to establish the local diagnostic reference levels (LDRLs) of computed tomography pulmonary angiography (CTPA) examinations based on body size with regard to noise magnitude as a quality indicator. The records of 127 patients (55 males and 72 females) who had undergone CTPAs using a 128-slice CT scanner were retrieved. The dose information, scanning acquisition parameters, and patient demographics were recorded in standardized forms. The body size of patients was categorized into three groups based on their anteroposterior body length: P1 (14-19 cm), P2 (19-24 cm), and P3 (24-31 cm), and the radiation dose exposure was statistically compared. The image noise was determined quantitatively by measuring the standard deviation of the region of interest (ROI) at five different arteries-the ascending and descending aorta, pulmonary trunk, and the left and right main pulmonary arteries. We observed that the LDRL values were significantly different between body sizes (p < 0.05), and the median values of the CT dose index volume (CTDIvol) for P1, P2, and P3 were 6.13, 8.3, and 21.40 mGy, respectively. It was noted that the noise reference values were 23.78, 24.26, and 23.97 HU for P1, P2, and P3, respectively, which were not significantly different from each other (p > 0.05). The CTDIvol of 9 mGy and dose length product (DLP) of 329 mGy∙cm in this study were lower than those reported by other studies conducted elsewhere. This study successfully established the LDRLs of a local healthcare institution with the inclusion of the noise magnitude, which is comparable with other established references.

Matched MeSH terms: Angiography; Computed Tomography Angiography
Fulltext Diagnostic dilemma of dural carotid cavernous fistula

Noorlaila B., Zunaina E., Raja Norliza R.O., Nor Fadzillah A.J., Alice, G.K.C.

Journal of Biomedical and Clinical Sciences, 2017;2(1):38-41.
MyJurnal

We report a case of dural carotid cavernous fistula (CCF) pose a diagnostic dilemma with initial symptoms of the arteriovenous shunt. A 56 year-old man presented with right eye diplopia, thensubsequently developed ptosis, congestion of conjunctiva, dilated episcleral vessels, and gradual rise in intraocular pressure. Initial diagnosis of pseudotumour was made based on negative finding of CCF by computed tomography angiography (CTA). In view of persistent clinical manifestations in spite of steroid therapy, and with the presence of new ocular signs; cock-screw conjunctival vessels, dilated retinal veins, and proptosis, digital subtraction angiography (DSA) was performed and confirmed the diagnosis of dural CCF.The ocular symptoms resolved completely post embolization of the fistula.

Matched MeSH terms: Angiography; Computed Tomography Angiography
Fulltext Image quality of coronary CT angiography (CCTA) using 640-slice scanner: qualitative and quantitative assessments of coronary arteries visibility

Shahril Shamsul, Akmal Sabarudin, Hamzaini Abdul Hamid, Norzailin Abu Bakar, Oteh Maskon, Muhammad Khalis Abdul Karim

Jurnal Sains Kesihatan Malaysia, 2020;18(2):49-57.
MyJurnal

The purpose of this study was to evaluate the image quality and diagnostic accuracy of coronary computed tomography angiography (CCTA) using 640-slice scanner. Advancement of multidetector computed tomography (MDCT) technology with higher spatial, temporal resolution, and increasing detector array have improved the image quality and diagnostic accuracy of CCTA. A total of 25 patients (12 men and 13 women) underwent CCTA examination was chosen and data was acquired by 640-slice scanner. All 16 segments of coronary arteries were evaluated by two reviewers using a 4-likert scale for qualitative assessment. In quantitative assessment, the evaluation of 4 main coronary arteries were analysed in terms of signal intensity (SI), image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). All 25 patients with a mean age of 52.88 ± 14.75 years old and body mass index (BMI) of 24.24 ± 3.28 kg/m2 were analysed. In qualitative assessment, from the total of 400 segments, 379 segments (95%) had diagnostic value while 21 segments did not have diagnostic value, which means 5% artefact was detected. In quantitative assessment, there was no statistical differences in gender, race, and BMI (p>0.05). Overall evaluation showed that higher SI at the left main artery (LM) at 393.7 ± 47.19. Image noise was higher at right coronary artery (RCA) at 39.01 ± 13.97. SNR and CNR showed higher at left anterior descending (LAD) with 12.73 ± 5.17 and LM 9.14 ± 4.2, respectively. In conclusion, this study indicates that 640-slice MDCT has higher diagnostic value in CCTA examination with 95% vessel visibility with 5% artefact detection.

Matched MeSH terms: Coronary Angiography; Computed Tomography Angiography
Fulltext Cerebral CT angiography and CT perfusion in acute stroke detection: a systematic review of diagnostic value

Sabarudin A, Subramaniam C, Sun Z

Quant Imaging Med Surg, 2014 Aug;4(4):282-90.
PMID: 25202664 DOI: 10.3978/j.issn.2223-4292.2014.07.10

The purpose of this study was to analyse the diagnostic value of cerebral CT angiography (CTA) and CT perfusion (CTP) examinations in the detection of acute stroke based on a systematic review of the current literature. The review was conducted based on searching of seven databases for articles published between 1993 and 2013. Diagnostic value in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy was analysed from 21 articles which were found to meet selection criteria. The mean sensitivity, specificity, PPV, NPV and accuracy for CTA were significantly higher than those for CTP with 83.2% (95% CI: 57.9-100.0%), 95.0% (95% CI: 74.4-100%), 84.1% (95% CI: 50.0-100%), 97.1 (95% CI: 94.0-100%) and 94.0% (95% CI: 83.0-99.0) versus 69.9% (95% CI: 20.0-97.0%), 87.4 (95% CI: 61.0-100.0%), 76.4% (95% CI: 48.0-95.4%), 78.2% (95% CI: 55.8-93.9%) and 89.8% (95% CI: 75.7-97.1%), respectively. This analysis shows that CTA has high diagnostic value in detecting high degree of cerebral arterial stenosis (>70%) whereas CTP provides high specificity in the detection of ischemia and infarct tissue of brain.

Matched MeSH terms: Cerebral Angiography; Computed Tomography Angiography
Fulltext Quantitative assessment on coronary computed tomography angiography (CCTA) image quality: comparisons between genders and different tube voltage settings

Chian TC, Nassir NM, Ibrahim MI, Yusof AK, Sabarudin A

Quant Imaging Med Surg, 2017 Feb;7(1):48-58.
PMID: 28275559 DOI: 10.21037/qims.2017.02.02

BACKGROUND: This study was carried out to quantify and compare the quantitative image quality of coronary computed tomography angiography (CCTA) between genders as well as between different tube voltages scan protocols.
METHODS: Fifty-five cases of CCTA were collected retrospectively and all images including reformatted axial images at systolic and diastolic phases as well as images with curved multi planar reformation (cMPR) were obtained. Quantitative image quality including signal intensity, image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of right coronary artery (RCA), left anterior descending artery (LAD), left circumflex artery (LCx) and left main artery (LM) were quantified using Analyze 12.0 software.
RESULTS: Six hundred and fifty-seven coronary arteries were evaluated. There were no significant differences in any quantitative image quality parameters between genders. 100 kilovoltage peak (kVp) scanning protocol produced images with significantly higher signal intensity compared to 120 kVp scanning protocol (P<0.001) in all coronary arteries in all types of images. Higher SNR was also observed in 100 kVp scan protocol in all coronary arteries except in LCx where 120 kVp showed better SNR than 100 kVp.
CONCLUSIONS: There were no significant differences in image quality of CCTA between genders and different tube voltages. Lower tube voltage (100 kVp) scanning protocol is recommended in clinical practice to reduce the radiation dose to patient.

Matched MeSH terms: Coronary Angiography; Computed Tomography Angiography
Fulltext Early Vessels Exploration of Pink Pulseless Hand in Gartland III Supracondylar Fracture Humerus in Children: Facts and Controversies

Tunku-Naziha TZ, Wan-Yuhana W, Hadizie D, Muhammad-Paiman, Abdul-Nawfar S, Wan-Azman WS, et al.

Malays Orthop J, 2017 Mar;11(1):12-17.
PMID: 28435568 MyJurnal DOI: 10.5704/MOJ.1703.005

The management of pink pulseless limbs in supracondylar fractures has remained controversial, especially with regards to the indication for exploration in a clinically well-perfused hand. We reviewed a series of seven patients who underwent surgical exploration of the brachial artery following supracondylar fracture. All patients had a non-palpable radial artery, which was confirmed by Doppler ultrasound. CT angiography revealed complete blockage of the artery with good collateral and distal run-off. Two patients were more complicated with peripheral nerve injuries, one median nerve and one ulnar nerve. Only one patient had persistent arterial constriction which required reverse saphenous graft. The brachial arteries were found to be compressed by fracture fragments, but were in continuity. The vessels were patent after the release of obstruction and the stabilization of the fracture. There was no transection of major nerves. The radial pulse was persistently present after 12 weeks, and the nerve activity returned to full function.

Matched MeSH terms: Angiography; Computed Tomography Angiography

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