Search Results (84)

Background/Objectives: Echocardiography is the reference standard for grading aortic stenosis (AS); however, it yields discordant severity estimates in up to 40% of patients. Multidetector computed tomography (MDCT)-derived methods for calculating aortic valve area (AVA) may improve diagnostic concordance, but their diagnostic performance, validation against invasive hemodynamics, and the influence of left ventricular outflow tract (LVOT) morphology on severity grading remain insufficiently investigated. Methods: We retrospectively analyzed 307 patients with normal-flow, high-gradient calcific AS who underwent echocardiography, MDCT, and cardiac catheterization. AVA was calculated using (1) echocardiographic LVOT diameter, (2) hybrid Doppler–MDCT planimetric LVOT area, and (3) corrected echocardiographic LVOT diameter (×1.13). Agreement, correlation, and diagnostic performance were assessed using Bland–Altman analysis, Pearson correlation, ROC analysis, and McNemar’s test. Subgroups defined by diagnostic concordance and MDCT-derived LVOT size were compared using ANOVA. Results: Hybrid AVA showed a strong correlation with echocardiographic AVA (r = 0.749, p < 0.001), with a mean difference of +0.11 ± 0.15 cm². Both methods demonstrated similar relationships with invasive and non-invasive hemodynamic markers of AS severity. When combined with echocardiography, the hybrid method increased concordant classification of severe AS by 8%. In contrast, corrected AVA performed significantly worse, leading to more discordant classifications. LVOT size was significantly associated with variability in AVA and Doppler velocity index, independent of flow status. Conclusions: Hybrid MDCT-derived AVA provides diagnostic performance equivalent to echocardiography and improves concordance in selected patients. LVOT size influences key echocardiographic parameters and may warrant tailored diagnostic thresholds. Full article

Background and Aim: Coronary calcification has been described as a manifestation of subclinical atherosclerosis. However, its predictors are not well established. The aim of this study was to evaluate the relationship between coronary artery calcium score (CACs) evaluated by multi-detector computed tomography (MDCT) and atherosclerotic cardiovascular disease (CVD) risk factors in symptomatic patients in three European countries. Method: We retrospectively analyzed 550 patients (age 62.7 ± 12 year, 47.5% females) who presented with atypical chest pain in Germany, Denmark, and Sweden. The demographic indices, CVD risk factors, and CACs were analyzed. The CV risk factors were classified as low (no risk factors), intermediate (1–2 risk factors), and high (≥3 risk factors). Patients were geographically classified into: Gr. I–German (n = 344), Gr. II–Danish (n = 84), and Gr. III–Swedish (n = 122) patients. Results: In the cohort as a whole, the mean CACs was 270.3 ± 72, and the intermediate risk was more prevalent than low and high-risk (p < 0.05 for all). Among the CVD risk profile, arterial hypertension (AH) was the most prevalent, followed by hypercholesterolemia, obesity, smoking, and diabetes (53, 38.2, 23.7, 17.6, and 10.5%; p < 0.05 for all). The German population was younger and had less CVD risk factors compared to the Danish and Swedish populations (p < 0.05, for all). CACSs adjusted to age and sex was lowest in Swedish patients, followed by German patients, and highest in Danish patients (p < 0.05). The CACs modestly correlated with age (r_pb = 0.52, p < 0.001), sex (r_pb = 0.48, p < 0.001), and extent of risk (r_pb = 0.35, p = 0.001). On multivariate regression analysis, hypercholesterolemia β = 185.1 (63.11 to 307.1), the extent of risk adjusted for age and sex β 3.741 (2.566 to 4.916; p < 0.001), and AH, β = 142.6 (11.25 to 274.1; p = 0.03) independently correlated with CACs. Furthermore, hypercholesterolemia was the only risk factor, consistently associated with CACs across all three countries. Conclusions: In symptomatic European patients, hypercholesterolemia is the main player in coronary calcium formation. Full article

Background/Objectives: This study aimed to investigate the relationships between facial morphology and alveolar crest cortical bone thickness and to determine the computed tomography (CT) values using multidetector CT (MDCT). Methods: A total of 39 subjects were categorized into three groups based on the Frankfort mandibular plane angle: low angle, average angle, and high angle. The thickness of the alveolar crest cortical bone and CT values between the canines and first premolars and between the second premolars and first molars in the maxilla and mandible were measured and analyzed from pre-treatment MDCT images. The Kruskal–Wallis and Dunn–Bonferroni tests were applied to investigate the relationships between facial types and alveolar crest cortical bone thickness, and to determine the CT values. Results: Significant differences in cortical bone thickness between the mandibular premolar and first molar were observed when comparing the high-angle group with the low-angle group (p = 0.001) and the average-angle group with the low-angle group (p = 0.022). Conclusions: These findings indicate that examining facial type may reveal differences in anchor loss in the mandibular molar region, which could prove useful in formulating treatment plans. Full article

Coronary artery aneurysms (CAAs) are an uncommon finding, and their rupture is an exceedingly rare and life-threatening complication. Giant aneurysms of the left main coronary artery (LMCA) pose a significant diagnostic and therapeutic challenge. We describe the case of a 62-year-old male who presented with acute coronary syndrome and was subsequently diagnosed with a ruptured giant LMCA aneurysm causing cardiac tamponade and multi-organ dysfunction. The initial diagnosis was suggested by coronary angiography and confirmed with contrast-enhanced multidetector computed tomography (MDCT) and echocardiography. The patient underwent emergency surgery consisting of aneurysm excision, thrombectomy, ligation of the LMCA ostium and its distal branches (LAD and circumflex), and coronary artery bypass grafting (CABG) using the left internal thoracic artery to the left anterior descending artery and a saphenous vein graft to a marginal branch. The patient’s postoperative course was complicated by transient multi-organ dysfunction, which resolved. He was discharged in a stable condition. This case highlights the critical importance of rapid multimodal imaging for diagnosis and the feasibility of emergency surgical intervention to achieve a favorable outcome in patients with a ruptured giant LMCA aneurysm. Full article

Background: Thoracic kyphosis has been increasingly associated with altered intra-abdominal and diaphragmatic dynamics, potentially contributing to gastroesophageal reflux disease (GERD) and hiatal hernia (HH). While previous studies have shown a relationship between spinal deformities and GERD symptoms, these findings have been largely observational, with few morphometric analyses. No prior study has directly quantified the relationship between thoracic curvature and hiatal surface area (HSA) using standardized computed tomography (CT)-based methods. Furthermore, existing studies have typically focused on patients with visible hernias, limiting understanding of early, subclinical anatomical changes. This study addresses this gap by evaluating whether thoracic kyphosis is associated with measurable hiatal enlargement, even in the absence of overt HH. Methods: In this retrospective, single-center study, 100 adult patients (50 with thoracic kyphosis, defined as a Cobb angle of ≥50° and 50 age- and sex-matched controls) underwent multidetector CT (MDCT). Hiatal surface area (HSA) was measured on a standardized oblique axial plane aligned with the diaphragmatic crura. Correlation and multivariable regression analyses were performed to assess relationships between Cobb angle and HSA. Results: The kyphosis group showed significantly larger HSA than controls (5.14 ± 1.31 cm² vs. 3.59 ± 0.74 cm²; p < 0.001). A moderate positive correlation was found between Cobb angle and HSA (r = 0.336, p = 0.017). Multivariable analysis identified the Cobb angle as an independent predictor of HSA (β = 0.028; p = 0.017), while age and sex were not significant predictors. No overt herniation was present in any subject. Conclusions: This is the first CT-based morphometric study to demonstrate that thoracic kyphosis is associated with hiatal enlargement, even in the absence of overt herniation. These findings support the hypothesis that postural spinal deformities may predispose individuals to GERD by structurally remodeling the diaphragmatic hiatus. Full article

The pancreas exhibits a uniquely intricate vascular architecture characterized by frequent and clinically significant morphological variations. These variations—impacting both arterial supply and venous drainage—are critical determinants in surgical planning, radiologic interpretation, and interventional outcomes. This comprehensive review examines the full spectrum of pancreatic vascular anatomy, with particular emphasis on embryological development, imaging manifestations, and surgical relevance. Key arterial structures, including the superior and inferior pancreaticoduodenal arteries (SPDAs and IPDAs) and the dorsal pancreatic artery (DPA)—are explored in detail alongside accessory branches. On the venous side, focus is placed on the gastrocolic trunk (GCT) of Henle, the uncinate and centro-inferior pancreatic veins, and the dorsal pancreatic vein (DPV). The review highlights that arterial aberrations, such as a DPA originating from the superior mesenteric artery (SMA), or duplicated patterns of the IPDA, as well as venous anomalies such as variant drainage of the GCT or the centro-inferior pancreatic vein, have substantial implications during pancreaticoduodenectomy, distal pancreatectomy, and transplantation procedures. With advances in multidetector computed tomography (MDCT), magnetic resonance angiography (MRA), and three-dimensional (3D) modeling, high-risk vascular variants can now be accurately mapped preoperatively, facilitating safer and more effective minimally invasive and robotic-assisted surgeries. In conclusion, the recognition and understanding of pancreatic vascular variations are imperative for optimal surgical and interventional management. This review underscores the importance of multidisciplinary collaboration among surgeons, radiologists, and anatomists, which will allow them to integrate detailed anatomical knowledge into clinical workflows, ultimately improving patient outcomes in pancreatic procedures. Full article

Background/Objectives: This study aimed to assess the potential of sternal morphometric parameters derived from multidetector computed tomography (MDCT) for sex estimation in a contemporary Greek population. A secondary objective was to develop and evaluate statistical and machine learning models based on these measurements for forensic identification. Methods: Sternal measurements were obtained from chest MDCT scans of 100 Greek adults (50 males, 50 females). Morphometric variables included total sternum length, surface area, angle, and index (SL, SSA, SA, and SI); manubrium length, width, thickness, and index (MBL, MBW, MBT, and MBI); sternal body length, width, thickness, and index (SBL, SBW, SBT, and SBI); and xiphoid process length and thickness (XPL and XPT). Logistic regression and a Random Forest classifier were applied to assess the predictive accuracy of these parameters. Results: Both models showed high classification performance. Logistic regression identified MBL and SBL as the most predictive variables, yielding 91% overall accuracy, with 92% sensitivity and 90% specificity. The Random Forest model achieved comparable results (91% accuracy, 88% sensitivity, 93% specificity), ranking SSA as the most influential feature. Conclusions: MDCT-derived sternal morphometry provides a reliable, non-invasive method for sex estimation. Parameters such as MBL, SBL, and SSA demonstrate strong discriminatory power and support the development of population-specific standards for forensic applications. Full article

Forensic medicine has increasingly integrated advanced imaging technologies to improve the accuracy and efficiency of investigations. Techniques such as virtual autopsy, multi-detector computed tomography (MDCT), and artificial intelligence (AI)-driven imaging have revolutionized the identification of injuries and causes of death. Despite these advancements, the field faces operational, ethical, and legal challenges that hinder widespread adoption. Objectives: This systematic review aimed to explore the role of emerging imaging technologies in forensic medicine, identify key challenges in their implementation, and provide insights into optimizing their use in forensic practice, with particular attention to cultural, ethical, and interdisciplinary aspects. Methods: A systematic review was conducted following PRISMA guidelines. Literature searches were performed across six databases, including PubMed, Scopus, Web of Science, and others, focusing on studies discussing imaging technologies in forensic contexts. A total of 10 studies were included after applying eligibility criteria. The data were synthesized using narrative synthesis and thematic analysis. Results: Four key themes emerged: (1) advancements in AI and imaging technologies, (2) operational and financial barriers, (3) ethical and legal considerations, and (4) interdisciplinary collaboration and training. Emerging imaging modalities enhance diagnostic precision and facilitate non-invasive examinations, offering culturally sensitive alternatives to traditional autopsies. However, high costs, algorithmic biases, data security risks, and the lack of standardized forensic imaging protocols present significant challenges. The potential for cross-cultural and international forensic collaborations through AI-enabled imaging was also identified as a promising future direction. Conclusions: Advanced imaging technologies hold transformative potential in forensic medicine. Addressing financial, ethical, and operational challenges through interdisciplinary collaboration, standardized guidelines, and culturally sensitive practices is crucial for maximizing their utility and global acceptance Full article

Coronary arteries may vary in quantity, point of origin, or course. These variations fall under the category of anatomical variants/anomalies of the coronary arteries, representing congenital abnormalities of the coronary vascular system. Generally, they are benign, asymptomatic, and identified inadvertently during coronary angiography conducted for alternative indications. However, in some cases, the anomaly’s characteristics or its interaction with surrounding structures may cause hemodynamic disturbances. These disturbances can lead to turbulent blood flow, which in turn poses an increased likelihood for the development of atherosclerosis and myocardial ischemia. If symptomatic, potential manifestations include chest pain, arrhythmias, syncope, myocardial infarction, and sudden cardiac death. Given the potential for life-threatening complications in certain cases, the early and accurate diagnosis of coronary artery anomalies is of paramount importance. The most common diagnostic procedures used for the evaluation of coronary vessels are coronary angiography and multi-detector row computed tomography (MDCT) coronary angiography. MDCT angiography is a non-invasive, dependable, safe, and sensitive method for the detailed visualization of coronary anatomy. It offers high-resolution imaging that enables precise assessment of congenital coronary variations, aiding in both clinical decision-making and long-term patient management. We conducted a narrative review to analyze and integrate the body of literature on coronary artery varieties and anomalies. Our objective was to provide a comprehensive, albeit non-exhaustive, overview of essential concepts and findings related to their definition, classification, and detection with MDCT angiography. By integrating current knowledge in MDCT imaging, we seek to contribute to a better understanding of the clinical implications of coronary artery variations and their role in cardiovascular health. Full article

Background/objectives: This study prospectively evaluated clinical outcomes and osseous consolidation in patients with symptomatic scaphoid non-union treated with avascular bone grafting and percutaneous screw fixation. Two imaging methods, MDCT (multi-detector computed tomography) and HR-pQCT (high-resolution peripheric quantitative computer tomography), were employed to assess bone healing. Methods: In Vienna, eight consecutive patients with nine symptomatic scaphoid non-unions underwent revision surgery. Clinical outcomes were measured using DASH and PRWE scores, grip strength, and thumb strength. MDCT and HR-pQCT imaging were conducted 6 and 12 weeks post-operatively. Results: The median DASH score improved significantly from 43.3 (range 3.3–76.7) pre-operatively to 26.6 (p = 0.024) at 3 months and 16.2 (p = 0.06) at 12 months post-operatively. At 5–6 years, the median DASH score was 2 (range 0–15). At 6 weeks, both MDCT and HR-pQCT detected >50% bone healing at the distal interface. At the proximal interface, HR-pQCT detected >50% healing in all cases, whereas MDCT still showed <50% healing in 25% of cases. By 12 weeks, both methods demonstrated >50% osseous consolidation at both interfaces. Conclusions: Avascular iliac grafting with screw fixation achieved excellent long-term clinical outcomes for symptomatic scaphoid non-union. HR-pQCT proved superior to MDCT for assessing early bone healing. Full article

Background. Pulmonary vein isolation (PVI) represents the cornerstone of paroxysmal (PAF) and persistent atrial fibrillation (PsAF) ablation. Impedance values provide insights on tissue conductive properties. Methods. Consecutive patients undergoing PAF and PsAF ablation were prospectively enrolled. All the patients underwent a preprocedural multidetector computed tomography (MDCT) to evaluate left atrial wall thickness (LAWT). Electroanatomic maps were acquired with the ablation catheter, and impedance values (Ω) and voltage amplitude (mV) of bipolar electrograms were collected. Results. A total of 60 patients (40 with PAF and 20 with PsAF) were included in the study. In all PAF cases, no voltage value lower than 0.5 mV was found at LA mapping; the corresponding mean impedance value was 151.5 ± 5.4 Ω. In PsAF cases, voltage values inferior to 0.05 mV have been reported in 19/20 patients. PsAF patients showed a mean impedance value of 129.1 ± 3.8 Ω. The correlation analysis between bipolar voltage and impedance reported an r_s value of 0.4166 (p < 0.001), showing a positive correlation between the two variables. On the contrary, no direct correlation was found between voltage and LAWT and between impedance and LAWT (rsv-t = 0.1838; rsi-t = 0.1133, respectively). Conclusions. This research study suggests a correlation between voltage amplitude and impedance values, so that impedance might be used for arrhythmogenic substrate characterization. Full article

Background: The measurement of Hounsfield units (HU) during implant treatment planning is important. Currently, various manufacturers’ implant planning software programs offer HU capabilities; however, their accuracy remains unverified. In this study, we aimed to validate the accuracy of HU values measured by implant planning software programs. Methods: This study used one type of multidetector computed tomography (MDCT), two types of cone–beam computed tomography (CBCT), and four implant planning software packages. Three specimens were prepared for the evaluation of HUs, and the standard values of the HUs were measured. Digital Imaging and Communications in Medicine (DICOM) data obtained from MDCT and CBCT were loaded into four implant planning software packages to measure the HU values. The HU and reference values of the four implant planning software programs obtained from MDCT and CBCT were compared. Additionally, the HU values between each implant planning software program were compared. Results: The HU values of the three specimens, as measured using the four implant planning software programs utilizing MDCT, did not exhibit a significant difference from the standard values. Conversely, those obtained from CBCT were significantly different. The measured HU values after the MDCT imaging of the specimens were not significantly different between the implant planning software programs; however, they differed after CBCT imaging. Conclusions: The results of this study indicate that it is not possible to measure HU values using CBCT with implant planning software programs. However, HU values can be measured by any implant planning software using MDCT. Full article

Background and Objectives: Haller Cells (HCs) represent the abnormal migration of ethmoid cells that are located below the ethmoid bulla at the level of the upper wall of the maxillary sinus. Through their placement, the cells can exert a mass effect on the infundibulum of the maxillary sinus. The aim of our study is to investigate the prevalence of Haller cells in the Romanian population and to evaluate the relationship between this anatomical variation and chronic rhinosinusitis. Secondly, we want to morphometrically evaluate the impact of Haller cells’ presence in the drainage paths of the maxillary sinuses. Materials and Methods: We conducted a randomised retrospective study that included 255 consecutive multi-detector computed tomography (MDCT) scans of the head. To carry out a comparative evaluation of the association of Haller cells with chronic rhinosinusitis, we divided the patients into two subgroups, a seasonal-based sample, between November 2022 and January 2023, and June 2023 and August 2023, respectively. We report the mean ± standard deviation for the continuous variables. To compare the results, we used the following statistical tests: a chi-squared test and a paired Student’s t-test (one-tail). Results: Our study identified a high prevalence of Haller cells, namely in 128 out of 255 patients (50.2%). There were no statistically significant associations between the presence of HCs and the age and the gender of the sample, respectively. The unilocular morphotype predominates in unilateral shapes and in bilateral shapes as well (p = 0.002). Our study identified the correlation between the Haller cells and the chronic rhinosinusitis in both research samples: “Winter group” and “Summer group” (p = 0.0002 and p = 0.0001, respectively). Conclusions: It was determined that for 40 out of 42 patients, the presence of HCs changes the morphometric pattern of the infundibular maxillary sinus. Full article

Objectives: To assess the feasibility of 5.0 T magnetic resonance imaging (MRI) in characterizing pancreatic cystic lesions (PCLs), compared with 3.0 T MRI and multidetector computed tomography (MDCT). Methods: Thirty-five patients with PCLs underwent 5.0 T MR alongside 3.0 T MR or MDCT. Two observers measured subjective and objective image quality scores. The consistency of two observers between 5.0 T and 3.0 T was calculated by intraclass correlation coefficients. The characteristics of PCLs and their specific diagnosis, as well as benignity/malignancy, were evaluated across MDCT, 3.0 T, and 5.0 T MRI. Results: The 5.0 T MR demonstrated significantly higher subjective image quality and SNR on T1WI compared to that in 3.0 T MR (p < 0.05). The 5.0 T MRI identified more cyst lesions than the 3.0 T MRI (40 and 32) and MDCT (82 and 56). The sensitivity, specificity, and accuracy for differentiating benign from malignant lesions with 5.0 T MRI (75%, 100%, and 91.4%, respectively) surpassed those of 3.0 T MRI and MDCT. The accuracy of the specific diagnosis of PCLs at 5.0 T MRI (80%) was superior to 3.0 T MRI and MDCT. Conclusions: 5.0 T MRI exhibits certain superiority in delineating details of PCLs and in clinical diagnostic accuracy, outperforming MDCT and 3.0 T MRI while maintaining sufficient image quality. Full article