Coronary artery calcifications: significance of incidental detection on CT scans

Article Abstract:

A scoring system for assessing coronary artery calcifications was developed in conjunction with computed tomography (CT) imaging in a study of 46 patients who had shown stenoses of at least 70 percent on cardiac catheterization. Coronary artery calcifications are usually caused by calcified plaques lining the inner walls of the coronary arteries (which bring oxygen to the heart muscle) and are evidence of some degree of atherosclerosis. The degree of calcification is a likely indicator of the severity and clinical importance of any coronary artery disease. CT provides excellent contrast resolution which enables the easy detection of coronary artery calcifications. The first half of the study revealed that many stenosed vessels showed no calcification, but when heavy calcifications were detected on CT scanning they were predictive of significant coronary artery disease. In the second half of the study CT scans provided useful information about coronary circulation in patients who were scheduled for thoracic (chest) surgery. Thirty pairs of patients matched for age and sex had CT scans prior to surgery which indicated that they did or did not have calcifications in their coronary arteries. The patients whose CT scans indicated the presence of calcifications had more frequent cardiac complications during surgery including arrhythmias (abnormal rhythms of the heartbeat), ischemia (lack of oxygen in the heart muscle), hypotension (drop in blood pressure), myocardial infarction (heart attack) and death. CT examination for calcifications is not sensitive enough to be used in mass screening. However, coronary artery calcifications, especially in a patient without symptoms of coronary artery disease, should alert both surgeons and anesthesiologists to the potential for cardiac complications during various types of thoracic surgery. Researchers recommend that an assessment of coronary artery calcifications be included as a standard part of reporting the results of chest CT scans.

Case studies, Diagnosis, Physiological aspects, Surgery, Calcification, Coronary arteries, Chest, Cardiac catheterization, Heart catheterization, Thoracic surgery

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Bacterial renal infection: role of CT

Article Abstract:

There are three stages of bacterial renal (kidney) infection: acute bacterial nephritis (ABN, infection of the kidney nephrons, the smallest working component of the kidney); interstitial inflammation (infection of spaces within an organ); and formation of an abscess. It is difficult to determine the exact stage of the disease in humans because of the inability to obtain pathologic specimens in the majority of cases. Researchers compared computed tomography (CT) imaging to intravenous urography (IVU) in a test of imaging techniques to establish the state of severe renal infection in 62 patients. Although IVU depicts more infections and infections of greater severity, IVU does not provide information that can be used in management and treatment of these infections. Furthermore, IVU frequently misses the presence of infection in the kidney. CT was the superior technique in most cases, but use of intravenous contrast material (substances that enhance the quality of a CT image) is important for the detection of renal inflammation. Some patients, however, cannot tolerate contrast material because of prior renal problems, or adverse reaction to the contrast agent. Contrast-enhanced CT is believed to be useful in determining when an intrarenal abscess stimulates the growth of a cyst. In CT studies performed without contrast agents, CT failed to detect ABN, nor was CT able to differentiate inflammatory, cystic, and neoplastic (multiple tumor growth) in images that were not contrast enhanced. About five percent of renal masses detected on CT scans were of an unidentified nature. CT scans, performed in conjunction with a contrast agent, were more sensitive than IVU for the detection of severe inflammatory disease in the kidney because CT better defines the extent of the disease. CT is also useful in guiding early therapy for bacterial renal infection.

Evaluation, Infection, Kidneys, Bacteria, Pathogenic, Pathogenic bacteria, Kidney, Urinary organs, Urinary tract

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