• Journal of radiological science and technology
• /
• v.37 no.4
• /
• pp.307-313
• /
• 2014

The purpose of this study is that in coronary artery angiography computed tomography (coronary CTA), to gain high quality of image and to use low dose radiation by administrating normal saline and converting the mode of scanning heart rate (HR) characteristics before infusing contrast media. All patients data (total specimens: 200, male: 108, female: 92) were measured by using appropriate mode of scanning the heart rate (HR) after injection of saline. in addition we measured radiation dose (CTDIvol, effective dose) in all examinations. CT number and noise, and blurring of coronary artery (proximal RCA, middle RCA, proximal LCA) were measured and compared. The result of this study after injection of saline, mean heart rate was decreased about $4.8{\pm}0.3bpm$ (beats per minute). 33 patients (13%) got converting scan mode due to reducing heart rate (HR). In prospective gating mode, radiation dose were measured less $6.0{\pm}1.0mSv$ (54.1%) than retrospective gating mode. Also showed a significant difference in heart rate decrease in image evaluation.

• Korean Journal of Radiology
• /
• v.21 no.9
• /
• pp.1055-1064
• /
• 2020

Objective: To assess the incremental prognostic value of coronary computed tomography angiography (CCTA) in comparison to a clinical risk model (Framingham risk score, FRS) and coronary artery calcium score (CACS) for future cardiac events in ischemic stroke patients without chest pain. Materials and Methods: This retrospective study included 1418 patients with acute stroke who had no previous cardiac disease and underwent CCTA, including CACS. Stenosis degree and plaque types (high-risk, non-calcified, mixed, or calcified plaques) were assessed as CCTA variables. High-risk plaque was defined when at least two of the following characteristics were observed: low-density plaque, positive remodeling, spotty calcification, or napkin-ring sign. We compared the incremental prognostic value of CCTA for major adverse cardiovascular events (MACE) over CACS and FRS. Results: The prevalence of any plaque and obstructive coronary artery disease (CAD) (stenosis ≥ 50%) were 70.7% and 30.2%, respectively. During the median follow-up period of 48 months, 108 patients (7.6%) experienced MACE. Increasing FRS, CACS, and stenosis degree were positively associated with MACE (all p < 0.05). Patients with high-risk plaque type showed the highest incidence of MACE, followed by non-calcified, mixed, and calcified plaque, respectively (log-rank p < 0.001). Among the prediction models for MACE, adding stenosis degree to FRS showed better discrimination and risk reclassification compared to FRS or the FRS + CACS model (all p < 0.05). Furthermore, incorporating plaque type in the prediction model significantly improved reclassification (integrated discrimination improvement, 0.08; p = 0.023) and showed the highest discrimination index (C-statistics, 0.85). However, the addition of CACS on CCTA with FRS did not add to the prediction ability for MACE (p > 0.05). Conclusion: Assessment of stenosis degree and plaque type using CCTA provided additional prognostic value over CACS and FRS to risk stratify stroke patients without prior history of CAD better.

• Archives of Plastic Surgery
• /
• v.46 no.6
• /
• pp.599-602
• /
• 2019

We report a case of autologous breast reconstruction in which a thoracodorsal vessel was used as a recipient vessel after a hypoplastic internal mammary vessel was found on preoperative computed tomography (CT) angiography. A 46-year-old woman with no underlying disease was scheduled to undergo skin-sparing mastectomy and breast reconstruction using a deep inferior epigastric artery perforator flap. Preoperative CT angiography showed segmental occlusion of the right subclavian artery with severe atherosclerosis and calcification near the origin of the internal mammary artery, with distal flow maintained by collateral branches. The thoracodorsal artery was selected to be the recipient vessel because CT showed that it was of adequate size and was not affected by atherosclerosis. The patient experienced no postoperative complications, and the flap survived with no vascular complications. The breasts were symmetrical at a 6-month follow-up. This case highlights that preoperative vascular imaging modalities may help surgeons avoid using diseased vessels as recipient vessels in free flap breast reconstructions.

• Journal of Chest Surgery
• /
• v.35 no.8
• /
• pp.599-604
• /
• 2002

Acute or chronic aortic dissection may lead to the rupture, which is the major cause of death. A dissecting aneurysm of ascending aorta(Stanford type A dissection) can rupture into the superior vena cava producing a aortocaval fistula, which is rare, but has been reported mostly in the cases of abdominal aortic aneurysm. We report a case of 67-year-old man with type A chronic dissection and aortocaval fistula, presenting symptoms of superior vena syndrome. The preoperative diagnosis was composed of radiologic examinations, including computed tomography, magnetic resonance imaging angiography and aortography. The dissecting aneurysm was resected and replaced, and the aortocaval fistula was repaired under deep hypothermic circulatory arrest. The details are described here.

• Journal of Pharmaceutical Investigation
• /
• v.31 no.2
• /
• pp.73-80
• /
• 2001

Lung perfusion scanning, invariably combined with ventilation studies provides a reliable and non-invasive mean to diagnose lung related pathologies despite the availability of modern techniques such as angiography, magnetic resonance imaging, magnetic resonance angiography, and helical (spiral) computed tomography. The technique involves the generation of images by radiations emitted from radioisotopes introduced in to the lungs. Various radiopharmaceuticals have been proposed and designed to incorporate $Tc^{99m}$ in to macroparticulate form for lung perfusion imaging. However, most of these have associated difficulties such as reproducibility of the product with regards to particle size distribution and poor elimination from the lung capillary bed. $Tc^{99m}$ macroaggregated albumin $(Tc^{99m}-MAA)$ is used extensively for clinical lung perfusion imaging and is considered as the radiopharmaceutical of choice. It is non-toxic, safe, and being biodegradable, is easily eliminated from the lung capillary bed by proteolytic enzyme metabolism and by mechanical forces due to lung movement.

• Journal of Korean Neurosurgical Society
• /
• v.56 no.5
• /
• pp.428-430
• /
• 2014

Isolated traumatic pseudoaneurysms of the basilar artery are extremely rare but often fatal resulting in a mortality rate as high as 50%. A 51-year-old man presented with craniofacial injury after blunt trauma. A brain computed tomography (CT) scan showed thick basal subarachnoid hemorrhage associated with multiple craniofacial fractures, while CT angiography revealed contrast extravasation at the distal basilar artery with pseudoaneurysm formation. After this primary survey, the condition of the patient suddenly deteriorated. Conventional angiography confirmed the contrast extravasation resulted from pseudoaneurysm formation, which was successfully treated with endovascular coil embolization. Decompressive craniectomy and coma therapy with propofol were also performed. However, the patient died on the 7th hospital day because of the poor initial clinical condition. The current case is the first report of acute pseudoaneurysm rupture arising from the basilar artery within the first day after trauma. Our findings suggest the possibility that pseudoaneurysm rupture should be considered if brain CT shows thick traumatic subarachnoid hemorrhage on the basal cistern with a basal skull fracture.

• Journal of Korean Neurosurgical Society
• /
• v.56 no.6
• /
• pp.531-533
• /
• 2014

We present a case of angiographically confirmed transection of the cisternal segment of the anterior choroidal artery (AChA) associated with a severe head trauma in a 15-year old boy. The initial brain computed tomography scan revealed a diffuse subarachnoid hemorrhage (SAH) and pneumocephalus with multiple skull fractures. Subsequent cerebral angiography clearly demonstrated a complete transection of the AChA at its origin with a massive extravasation of contrast medium as a jet trajectory creating a plume. We speculate that severe blunt traumatic force stretched and tore the left AChA between the internal carotid artery and the optic tract. In a simulation of the patient's brain using a fresh-frozen male cadaver, the AChA is shown to be vulnerable to stretching injury as the ipsilateral optic tract is retracted. We conclude that the arterial injury like an AChA rupture should be considered in the differential diagnosis of severe traumatic SAH.

• Journal of Korean Neurosurgical Society
• /
• v.48 no.4
• /
• pp.354-356
• /
• 2010

Partial thrombosis of giant aneurysms is not uncommon however, complete angiographic occlusion occurs less frequently. In the case of non-giant aneurysms, complete thrombosis and recanalization has been rarely reported. A 31-year-old man presented to the emergency department with sudden bursting headache. Brain computed tomography (CT) revealed diffuse subarachnoid hemorrhage on the left side. Both CT angiography (CTA) and digital subtraction angiography showed suspicion of small left anterior choroidal artery aneurysm. We performed surgical exploration. In the operation field, anterior choroidal artery aneurysm of $2{\times}2\;mm$ with broad neck and friable appearance was observed. Because we could not clip without sacrificing the anterior choroidal artery, we performed wrapping only. Follow up CTA after 7 months demonstrated 4 mm right internal carotid artery bifurcation aneurysm. The patient underwent aneurismal neck clipping. During the operation, $9{\times}13\;mm$ sized thrombosed aneurysm was detected and completely clipped. We initially thought this aneurysm to be a de novo aneurysm however, it was an aneurysm that had recanalized from a completely thrombosed aneurysm. This case report provides an insight into the potential for complete thrombosis and recanalization of non-giant aneurysms.

• Journal of Yeungnam Medical Science
• /
• v.29 no.1
• /
• pp.24-27
• /
• 2012

Mycotic hepatic artery aneurysms (HAAs) have become very rare due to antibiotics. Untreated, they have a high possibility of rupture and mortality. In this paper, on the case of a 67-year-old male who had severe right-upper-quadrant abdominal pain and a history of infective endocarditis is reported. The computed tomography (CT) and arterial angiography findings led to a diagnosis of a ruptured mycotic HAA. The CT showed an HAA and the formation of an intrahepatic hematoma caused by aneurysmal rupture. The arterial angiography showed a mycotic HAA that arose from the right posterior hepatic artery. Percutaneous transcatheter arterial embolization was used to successfully treat the HAA. Since then, the patient has been doing well, without symptoms.

• Journal of Korean Neurosurgical Society
• /
• v.52 no.5
• /
• pp.501-504
• /
• 2012

Objective : To report our surgical experience using in situ end-to-side bypass for giant serpentine distal anterior cerebral artery aneurysm, unsuitable for microsurgical clipping. Methods : A 49-year-old woman presented with headache and intermittent loss of consciousness. The brain computed tomography scan revealed a partially calcified mass in the interhemispheric fissure. On cerebral angiography, that was giant ($30{\times}18mm$ sized), serpentine aneurysm originating from the A2 to A3 segment of the distal anterior cerebral artery (DACA). The aneurysm was trapped with clips, and the right A3 segment to left A3 segment of DACA, end-to-side in situ bypass was performed. Surgical result was favorable, with no newly developed ischemic event in the acute recovery period. Postoperative angiography showed total occlusion of the aneurysm and good patency, with preserved distal flow. Conclusion : Giant fusiform aneurysms of the DACA are extremely rare and can be particularly challenging to treat. End-to-side A3 : A3 bypass with aneurysm trapping could be a treatment modality for these locations.