Claudication due to adventitial cystic degeneration: A differential diagnosis of peripheral artery disease

Background Cystic adventitial disease (CAD) is an important and rare non-atherosclerotic cause of intermittent claudication and critical limb ischemia. Since the first case of CAD involving the external iliac artery was described by Atkins and Key in 1947, approximately 300 additional cases have been reported. Objectives The aim of this article is to report a rare vascular disorder, predominantly seen in young healthy men with minimal cardiovascular risk factors. Methods We report a rare case of cystic adventitial disease of a young policeman. To confirm the diagnosis, an ultrasonography and a conventional angiography were performed. The therapeutic approach was surgical first. Results The procedure was successful without any complication, and the patient was discharged to home 4 days after procedure. Conclusion While CAD is rare, the diagnosis should be suspected in a young patient who presents with arterial insufficiency and no risk factors for atherosclerosis. Catheter angiography is the investigation of choice in the absence of multislice CT and good MRA. It seems that the treatment that assures the best long-term results is reconstructive arterial bypass surgery.

Sensitivity of modern multislice CT for subarachnoid haemorrhage at incremental timepoints after headache onset: a 10-year analysis

BackgroundCT performed within 6 hours of headache onset is highly sensitive for the detection of subarachnoid haemorrhage (SAH). Beyond this time frame, if the CT is negative for blood, a lumbar puncture is often performed. Technology improvements in image noise reduction, resolution and motion artefact have enhanced the performance of multislice CT (MSCT) and may have further improved sensitivity. We aimed to describe how the sensitivity to SAH of modern MSCT changes with time from headache onset.MethodsThis was a retrospective analysis of electronic data collected as part of routine care among all patients presenting to Christchurch Hospital diagnosed with a SAH between 1 January 2008 and 31 December 2017. Patients were imaged with MSCT. The primary outcome was the proportion of patients with spontaneous aneurysmal SAH (identified via coding and confirmed by clinical and radiological records) that had a positive MSCT. The secondary outcome was the proportion of patients with any type of spontaneous SAH that had a positive MSCT.ResultsThere were 347 patients with an SAH of whom 260 were aneurysmal SAH. MSCT identified 253 (97.3%) of all aneurysmal SAH and 332 (95.7%) of all SAH. The sensitivity of MSCT was 99.6% (95% CI 97.6 to 100) for aneurysmal SAH and 99.0% (95% CI 97.1 to 99.8) for all SAH at 48 hours after headache onset. At 24 hours after headache onset, the sensitivity for aneurysmal SAH was 100% (95% CI 98.3 to 100).ConclusionThese data suggest that it may be possible to extend the timeframe from headache onset within which modern MSCT can be used to rule out aneurysmal SAH.

Clinical Research of Combined Application of DCEUS and Dynamic Contrast-Enhanced MSCT in Preoperative cT Staging of Gastric Cancer

Purpose. To investigate the clinical value of double contrast-enhanced ultrasound (DCEUS) combined with dynamic contrast-enhanced multislice CT (MSCT) in preoperative T staging of gastric cancer (GC). Methods. 206 patients with GC confirmed by preoperative gastroscopy from February 2019 to February 2021 were collected, all patients were examined by DCEUS and dynamic contrast-enhanced MSCT before operation, and the invasion depth (T staging) of GC was evaluated. The diagnosis results of DCEUS, dynamic contrast-enhanced MSCT, and combined diagnosis of DCEUS and MSCT methods (D&M method) were compared with the pathological staging results (gold standard). Results. The correct diagnosis rate of MSCT was 27.27% in T1 staging, 55.56% in T2 staging, 42.11% in T3 staging, 59.29% in T4 staging, and 55.34% in summation. The correct diagnosis rate of DCEUS was 90.91% in T1 staging, 88.89% in T2 staging, 78.95% in T3 staging, 82.86% in T4 staging, and 83.98% in summation. The correct diagnosis rate of the D&M method was 100.00% in T1 staging, 94.44% in T2 staging, 89.47% in T3 staging, 93.57% in T4 staging, and 93.69% in summation. The D&M method had higher correct diagnosis rate than MSCT or DCEUS alone, the correct diagnosis rate of the D&M method in T1, T2, T3, and T4 staging was significantly higher than that of MSCT ( P < 0.05 ). The correct diagnosis rate of the D&M method in T1, T3, and T4 was significantly higher than that of DCEUS ( P < 0.05 ). The Youden index of preoperative T1, T2, T3, and T4 staging of GC by the D&M method was 99.49%, 94.44%, 84.13%, and 90.54%, respectively, and the Kappa values of these were 0.954, 0.966, 0.707, and 0.881, respectively. Conclusions. Dynamic contrast-enhanced MSCT combined with DCEUS in the diagnosis of preoperative cT staging of GC has more validity, reliability, and revenue than the using of MSCT or DCEUS alone, which is an image evaluation method worthy of clinical promotion.

Utility of 3D CT Rib Study in Presurgical Planning of Autologous Ear Graft for Pinna Reconstruction in Microtia

Purpose The aim of this study was to demonstrate the utility of three-dimensional computed tomography (3D) CT rib study in presurgical planning to select the autologous rib cartilage graft for pinna reconstruction. Materials and Methods Total of 35 patients of microtia for autologous rib graft from April 2017 to February 2020 were evaluated in this study. All patients had a plain low-dose multislice CT chest. The length of costal cartilages of sixth to ninth ribs bilaterally and width and height of sixth and seventh rib costal cartilage synchondrosis were measured in 3D reconstructed true size coronal images with best possible length displayed. All patients had high-resolution computed tomography (HRCT) temporal studies done to evaluate for associated anomalies in external canal, middle ear cavities, and inner ear structures. Eleven patients had simultaneous HRCT temporal bone done after plain CT chest and rest who had done recent prior study were reviewed without repetition of study. Results There were 19 males and 16 females for 3D CT rib study. Average age of the participants was 16.5 years. The average width of synchondrosis of sixth and seventh rib was 15.4 mm on right side and 14.7 mm on left side, average height of synchondrosis was 28.5 mm on right side and 30.7 mm on left side. Average length of the eighth rib costal cartilage was 88.6 mm on the right side and 90.5 mm on the left side. Average length of the ninth rib was 63.2 mm on the right side and 58.2 mm on the left side. Costal cartilage calcifications were present in 9 patients. Conclusion Preoperative 3D CT rib study provides accurate measurements of rib stock for sculpting autologous ear graft.

IL-6 Is Associated with Progression of Coronary Artery Calcification and Mortality in Incident Dialysis Patients

<b><i>Introduction:</i></b> Inflammation is important in the pathogenesis of atherosclerosis. Elevated interleukin-6 (IL-6) is associated with cardiovascular events and also predicts mortality in individuals with CKD. Our goal was to determine the association between IL-6, FGF23, and high-sensitivity C-reactive protein (hsCRP) on coronary artery calcification (CAC) progression and mortality in incident dialysis patients without prior coronary events. <b><i>Methods:</i></b> A prospective cohort of incident adult dialysis participants had CAC measured by ECG-triggered multislice CT scans at baseline and at least 12 months later. Lipids, mineral metabolism markers, FGF23, and inflammatory markers, such as IL-6 and hsCRP, were measured at the baseline visit. <b><i>Results:</i></b> Participants in the high IL-6 tertile had the highest baseline CAC score (133.25 [10.35–466.15]) compared to the low (0.25 [0–212.2]) and intermediate (29.55 [0–182.85]) tertiles. Almost half of the participants with high IL-6 (15 of 32 [46.9%]) experienced progression of CAC compared to participants with low (8 of 32 [25%]) and intermediate (9 of 32 [28.1%]) (<i>p</i> = 0.05) IL-6 levels. Each log increase in IL-6 was associated with increase in death (hazard ratio 2.2, 95% CI: 1.2–3.8; <i>p</i> = 0.01). After adjusting for smoking, age, gender, race, diabetes, phosphate, and baseline calcium score, IL-6 (log) was associated with 2.2 times (95% CI: 1.1–4.6; <i>p</i> = 0.03) increase in death. <b><i>Conclusion:</i></b> IL-6 is associated with progression of CAC and mortality in incident dialysis patients.

Diagnostic Accuracy of Multislice Contrast CT scan in Detection of Squamous cell Carcinoma of Oral cavity, in clinically suspected Patients

Objective: To evaluate the diagnostic accuracy of multislice computed tomography (CT) in detection of squamous cell carcinoma (SCC) of oral cavity in clinically suspected patients taking histopathology as gold standard. Material and Methods: This cross-sectional study has been conducted at Radiology department of Civil Hospital Karachi from 8th September 2018 to March 2019. All the cases having suspected oral squamous cell carcinoma and either of gender were included. Patients underwent computed tomography by using multislice scanner. Then patients undergone biopsy sampling and patients were labeled as positive or negative for squamous cell carcinoma of oral cavity on MDCT and histopathology. Sensitivity, specificity, and diagnostic accuracy of multislice CT for squamous cell carcinoma of oral cavity were measured taking histopathology as gold standard. Results: Total 168 cases were studied and out of them males were 76.8% and females were 23.2%. Mean gutka addiction history was 11.52±5.21 years. Mean lesion size on CT scan was 2.44±1.43 cm. In our study, 35.1% patients were diagnosed positive by multislice computed tomography and 43.5% through histopathology. Sensitivity, Specificity, PPV, NPV and accuracy were 86.4%, 79.8%, 69.9%, 91.6%, and 82.1% respectively. Conclusion: Multislice CT observed to be the effective diagnostic tool for the detection of SCC of oral cavity. Keywords: Multislice Computed Tomography, cancer, Oral Cavity