Abnormalities in LAD but not in plaque

Abnormalities in LAD but not in plaque
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Clinical history

This 66-year-old female presented at PRC Shenton House wtih untreated hypercholesterolemia and chest pain. Invasive angiography performed four years earlier showed minor luminal irregularity in the left anterior descending (LAD) artery. Coronary CTA was requested to assess whether there was any progression of disease.
The technologist successfully performed a coronary CT using axial prospective gating (Step & Shoot Cardiac) on the Ingenuity CT system.

Image scan parameters

  • 55 ± 4 bpm heart rate

  • 80 kVp

  • 5.4 mGy CTDIvol

  • 62.4 mGy x cm DLP

  • 200 mAs

  • 0.87 mSv (k=0.014*) effective dose

* AAPM Technical Report 96

Diagnosis

The images acquired on the Ingenuity CT showed that the right coronary artery (RCA) was normal (Figure 1a). However, a non-calcified plaque was observed in the LAD artery (Figure 1b), showing a minor luminal irregularity causing <25% diameter stenosis (grey arrow).

Clinical significance

The overall image quality was excellent with no motion or step artifact present. Contrast enhancement in the aortic root was 700 HU.
* Results from case studies are not predictive of results in other cases. Results in other cases may vary.

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Evaluation of Plaque in segments of the LAD and RCA

Evaluation of Plaque in segments of the LAD and RCA

Clinical history Of Patient

This 66-year-old female presented at PRC Shenton House with a new onset of exertional dyspnea. A transesophageal echocardiogram (TEE) showed a partial filling defect suspicious for stenosis in the proximal LAD (Figure 2a), and coronary CTA was requested for confirmation. The technologist used the Ingenuity CT system to perform the exam.

Image scan parameters

  • 58 bpm heart rate

  • 100 kVp

  • 17.1 mGy CTDIvol

  • 186.7 mGy x cm DLP

  • 300 mAs

  • 2.6 mSv (k=0.014*) effective dose

* AAPM Technical Report 96

Diagnosis

A predominantly non-calcified plaque was seen in the proximal segment of the LAD causing 70-90% stenosis, correlating with the echo findings (Figure 2b, green arrow). Additionally, a mixed plaque was also seen in the mid-segment of the RCA, causing 25-50% stenosis, and in the distal segment with <25% stenosis (Figure 2c, green arrows). The LAD was subsequently stented.

Clinical significance

The overall image quality was good, with a contrast enhancement of 591 HU in the aortic root.
The iPatient tools enable the technologist to quickly optimize parameters for cardiac scanning, enabling increased diagnostic quality from 84% to 90% and thus providing consistent high-quality coronary CT exams as part of PRC Shenton House's diagnostic radiology services.
* Results from case studies are not predictive of results in other cases. Results in other cases may vary.

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Ultrasound Images Dysmenorrhea

pat of age about 38 years with Dysmenorrhea




This ultrasound images,  i take in my forum or group face book,  this images very interesting for learning view about Dysmenorrhea, Dysmenorrhea ultraaound .images

Appearance of Hydronephrosis in ultrasound images

Hydronephrosis refers to a kidney with a dilated pelvis and collecting system. It can be caused by obstruction of the ureters or bladder outlet. Hydronephrosis can also result from reflux (retrograde leakage of urine from the bladder up the ureters to the renal pelvis. Rarely, some children have hydronephrosis without either obstruction or reflux. This is thought to result form abnormal smooth muscles of the renal pelvis or ureter causing ectasia.

 This ultrasound image demonstrates dilated renal calyces indicative of hydronephrosis. Chronic reflux uropathy can lead to hydronephrosis which can result in renal dysfunction as the calyces dilate and compress the renal parenchyma.
*Black arrow = renal capsule
*Black arrowhead = sinus fat
*White arrow = dilated calyx
*White arrowhead = renal cortex

This longitudinal ultrasound shows a kidney with moderate hydronephrosis. The parenchyma is relatively normal in thickness. The dilation of the collecting system extends from the renal pelvis to the calyces. This is a grade III hydronephrosis.

CT scan images of Blunt trauma to the spleen

Spleen is the most commonly injured solid intra-abdominal organ and the Blunt trauma is the most common cause.
Often (40%) associated with lower rib fractures and left renal injury.
In 20% of patients with left rib fractures, there is a concomitant splenic injury.
25% of patients with left renal injuries also have splenic injuries.
Damage ranges from subcapsular haematoma to total splenic laceration, potentially leading to exsanguination.
Rupture of the spleen. This CT shows Rupture of the anterior half of the spleen caused by blunt trauma in falling from a horse.Haemorrhage is seen within the splenic bed (arrow) along with free blood around the liver (arrowhead).

Splenic laceration (arrow).
 CT scan images of Blunt trauma to the spleen

Ultrasound Images of Subchorionic cyst lesion of the placenta


These ultrasound images show a cystic lesion in the placenta,located  just below the placental surface. Few mobile echoes were seen within the lesion. No other abnormalities were seen in the placenta and the fetus. This finding is generally considered to be insignificant clinically. However some reports suggest an association with fetal IUGR (Intrauterine growth retardation).

Cost vs Benefits you should know: to Compare 64-Slice to 256, 320-Slice CT

Cost vs Benefits you should know: to Compare 64-Slice to 256, 320-Slice CT
 In this era of financial cost cutting, questions are raised over the true need for 256- or 320-slice computed tomography (CT) systems for cardiac imaging. There are many radiologists and cardiologists who argue a 64-slice CT system is good enough to make a cardiac diagnosis without spending twice as much for the higher-slice systems. However, those who adopted 256- or 320-slice systems say the quality of the images are superior and lead to better diagnoses in CT angiography (CTA).
System users say 64-slice scanner costs a little more than $1 million, while a 256-slice scanner runs about $2 million, and a 320-slice system costs about $2.5 million.
Diagnostic and Invasive Cardiology spoke with cardiac imaging specialists to gain their insights into this debate.
Watch an updated video from SCCT 2016 explaining the differences in newer generation CT systems — What to Consider When Comparing 64-slice to Higher Slice CT Systems.

Watch video explaining recent trends in CT technology — “RSNA Technology Report 2015: Computed Tomography” — where Contributing Editor Greg Freiherr describes computed tomography advances shown at RSNA 2015

Better Diagnostic Images
This debate over the use of established and new technology happens with every new generation of CT, said Michael Vannier, M.D., FACR, professor of radiology and medicine at the University of Chicago Medical Center. “In an ideal world you have patients with low heart rates, they can hold their breath and they don’t have lots of disease. With these conditions you can get great images with just about any CT scanner,” he said
However, the realities are some patients have arrhythmias, fast heart rates, are obese, and pediatric patients squirm. He said these conditions are better suited for high-slice systems, which are faster and offer a larger imaging area. These were among the reasons why the University of Chicago Medical Center purchased a Philips 256-slice Brilliance iCT system.

“The 256-slice scanner costs substantially more than the 64-slice systems. We were skeptical at first, but it was apparent from the start the quality of the exams were much better,” Vannier said. “I don’t think any of our physicians would use a 64-slice system anymore for these cardiac examinations. We were accustomed in the past to having some studies that were just uninterpretable. But today, that has largely gone away.”
While the cost is high, the image quality from a Toshiba Aquilion One 320-slice scan provides much better patient care through more accurate diagnoses, said Michael Poon, M.D., FACC, professor of medicine and radiology, director of advanced cardiac imaging, Stony Brook University Medical Center, Stony Brook N.Y.