Following diagnostic dacryocystography, balloon catheter dilatation is a low risk and very successful treatment of complicated connatal obstructed nasolacrimal duct system.
ZusammenfassungHintergrund: Welche Informationen kann die CT-Angiographie (CTA) im Rahmen der Notfalldiagnostik bei Patienten mit operationspflichtiger nichttraumatischer Hirnmassenblutung liefern? Patienten und Methode: Bei 61 Patienten mit nichttraumatischer Hirnmassenblutung und dringlicher Operationsindikation wurde im Anschluss an das Nativ-CT eine CTA zur Blutungsquellensuche durchgeführt. Die Befunde der CTA wurden mit dem intraoperativen Befund und der histologischen Aufarbeitung der Operationspräparate verglichen. Die CTAs der Patienten mit operativ nachgewiesener Gefäßmalformation wurden retrospektiv nach spezifischen Befundkriterien analysiert. Ergebnisse: Die CTA konnte präoperativ 13 arteriovenöse Malformationen (AVM), eine Carotis-Sinus-cavernosus-Fistel und drei Aneurysmen als Blutungsquelle richtig nachweisen. In einem Fall bestätigte sich der Angiomverdacht operativ nicht. Singuläre oder komplexe pathologische Gefäßstrukturen in der CTA haben eine sichere Korrelation mit den operativen und histologischen Befunden eines AV-Angioms. Punktförmige Kontrastmittelaustritte im Hämatom sind dagegen unsichere Befundkriterien für ein Angiom. Schlussfolgerung: Bei der raumfordernden Massenblutung bleibt oft keine Zeit für eine diagnostische DSA zur Blutungsquellensuche. Mit einer im Anschluss an das Nativ-CT durchgeführten CTA lassen sich größere Angiome und periphere Aneurysmen als Blutungsursache ohne wesentlichen Zeitverzug nachweisen. Schlüsselwörter: Intrazerebrale Blutung · CT · CTA · DSAAbstract Background: What diagnostic information can emergent CT angiography (CTA) supply in the setting of nontraumatic massive intracerebral hemorrhage requiring surgical treatment? Patients and Methods: In 61 patients with massive nontraumatic intracerebral hemorrhage requiring urgent surgical treatment a CTA following a nonenhanced CT (NECT) was performed. The results of the CTA were compared with the intraoperative and histological findings. In the cases with histologically proven vascular malformations the CTAs were retrospectively analyzed according to specified criteria. Results: CTA was able to correctly identify 13 arteriovenous malformations, one carotid cavernous fistula and three aneurysms as the underlying cause of the intracerebral hemorrhage. In one case a suspected angioma could not be confirmed intraoperatively. There is a high correlation between single or complex pathological vascular structures in the CTA and intraoperative and histological findings of AVMs. In contrast, nodular appearing extravasation of the contrast agent within the hematoma is an unreliable finding with regard to the presence of an angioma.
Purpose: The K-edge of gold (81 keV) is located within the energy range of diagnostic CT. This might be advantageous for material differentiation in dual-energy CT (DECT). The aim of this in vitro study was to compare the differentiation between iodine or gold and body tissues using DECT at different kV spectra. Methods and Materials: A water filled tank phantom containing specimens with iodine (iopamidol), gold (sodium aurothiomalate), compact bone (compact porcine bone) and porcine muscle was scanned using a dual source CT (Definition, Siemens Healthcare). Consecutive scans were performed at 80 kVp, 100 kVp, 120 kVp and 140 kVp with constant mAs settings. The mean attenuation values of the specimens were measured, and differences in calculated dual-energy ratios (DE ratio) between body tissues and iodine or gold were determined for different DE spectra. Results: The attenuation of gold increased compared to 80 kVp at higher kVp-settings, while the attenuation of all other specimens decreased. The calculated DE ratios at 80/100 kVp, 80/120 kVp and 80/140 kVp were 1.31, 1.62 and 1.91 for iodine, 0.89, 0.88 and 0.92 for gold, 1.20, 1.39 and 1.45 for compact bone, 1.01, 1.03 and 1.08 for muscle. The differences between the DE ratios 80/100 kVp, 80/120 kVp and 80/140 kVp were 0.11, 0.23 and 0.46 for iodine and bone, 0.31, 0.51 and 0.53 for gold and bone, 0.29, 0.59 and 0.83 for iodine and muscle, 0.12, 0.15 and 0.16 for gold and muscle. Conclusion: DE ratio of gold remains relatively stable along the energy spectrum of diagnostic CT and allows a reliable material differentiation between gold and bone already at contiguous low tube voltage settings (80 kV and 100 kV). Thus, gold might have a potential as a contrast agent for DECT.
CT angiography is suitable for detailed evaluation of the cerebral veins. Anatomic variants, arachnoid granulations, as well as fibrous bands and septa, which may lead to misinterpretation in conventional CT, can be clearly demonstrated. The sensitivity and specificity of CT in diagnosis of sinovenous thrombosis were increased thereby.
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