{"id":9686,"date":"2020-11-14T13:03:09","date_gmt":"2020-11-14T18:03:09","guid":{"rendered":"https:\/\/cornflowerblue-rail-980953.hostingersite.com\/?p=9686"},"modified":"2020-11-15T01:06:43","modified_gmt":"2020-11-15T06:06:43","slug":"whats-new-in-cardiothoracic-imaging-turkish-november-2020","status":"publish","type":"post","link":"https:\/\/staging-hub.acoredu.com\/tr\/whats-new-in-cardiothoracic-imaging-turkish-november-2020\/","title":{"rendered":"What’s new in Cardiothoracic Imaging (Turkish) – November 2020"},"content":{"rendered":"
Kalsiyum Skorlamas\u0131: Koroner BT anjiyografisine ek veya alternatif testlere olan ihtiyac\u0131 \u00f6ng\u00f6ren ki\u015fiselle\u015ftirilmi\u015f bir olas\u0131l\u0131k de\u011ferlendirmesi<\/strong><\/span><\/h5>\n

Judit Simon, Lili Sz\u00e1raz, B\u00e1lint Szilveszter, Alexisz Panajotu, \u00c1d\u00e1m Jermendy, Andrea Bartykowszki, Melinda Boussoussou, Borb\u00e1la Vattay, Zs\u00f3fia D\u00f3ra Drobni, B\u00e9la Merkely, P\u00e1l Maurovich-Horvat\u00e1 ve M\u00e1rton Kolossv\u00e1ry<\/p>\n

European Radiology, 2020; 30 (10): 5499\u20135506<\/p>\n

MTA-SE Kardiyovask\u00fcler G\u00f6r\u00fcnt\u00fcleme Ara\u015ft\u0131rma Grubu ve Macaristan’daki Semmelweis \u00dcniversitesi’nden ara\u015ft\u0131rmac\u0131lar, koroner bilgisayarl\u0131 tomografik anjiografide(BTA) tan\u0131sal olmayan g\u00f6r\u00fcnt\u00fcler veya \u00f6nemli derecedeki stenozlar varsa, kalsiyum skorunun(KKS) antropometik ve risk fakt\u00f6rlerine ek olarak alternatif tan\u0131sal de\u011ferlendirmenin faydal\u0131 olup olamayaca\u011f\u0131na karar vermede kullan\u0131m\u0131n\u0131 de\u011ferlendirdiler. Ara\u015ft\u0131rmac\u0131lar, en az 1 koroner segmentte tan\u0131sal olmayan BTA’l\u0131 276 hastay\u0131 i\u00e7eren 4120 hastay\u0131 retrospektif olarak incelediler ve bu hastalar\u0131n 1073’\u00fcnde en az %50 darl\u0131k vard\u0131. Ara\u015ft\u0131rmac\u0131lar, hipotezlerini test etmek i\u00e7in birden fazla model kulland\u0131lar. Kullan\u0131lan Model 1, beden kitle indeksi (BMI), nab\u0131z ve aritmi i\u00e7eriyordu. Model 2, model 1’in bile\u015fenlerinin yan\u0131 s\u0131ra ya\u015f, cinsiyet ve anjina tipini de i\u00e7eriyordu. Model 3, model 2’nin bile\u015fenlerini ve KKS’yi i\u00e7eriyordu. Model 1’in zay\u0131f tan\u0131sal do\u011frulu\u011fa (EAA 0,56) sahip oldu\u011fu g\u00f6sterildi, ancak model 2’ye dahil edildi\u011finde ay\u0131rt etme g\u00fcc\u00fcn\u00fcn artt\u0131\u011f\u0131 (EAA 0,72, p <0,001) ve ek olarak CACS (model 3) eklendi\u011finde ay\u0131rt etme g\u00fcc\u00fcn\u00fcn tekrar geli\u015fti\u011fi (EAA 0,84), p <0.001) g\u00f6sterildi. Olas\u0131l\u0131k oranlar\u0131, a\u015fa\u011f\u0131dakileri i\u00e7eren bir\u00e7ok fakt\u00f6r i\u00e7in de olu\u015fturulmu\u015ftur: her t\u00fcr aritmi, ileri tan\u0131 testi olas\u0131l\u0131\u011f\u0131n\u0131 2.12 art\u0131rm\u0131\u015ft\u0131r; atipik anjina 1.29; ve tipik anjina 1.64 (t\u00fcm\u00fc p <0.001). Tan\u0131sal olmayan BTA g\u00f6r\u00fcnt\u00fc kalitesi ile \u00fc\u00e7 modelin sonu\u00e7lar\u0131 kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda, ay\u0131rt etme g\u00fcc\u00fcn\u00fcn artt\u0131\u011f\u0131n\u0131 g\u00f6steren anlaml\u0131 bir model yoktu (p> 0.05). BTA\u2019da g\u00f6sterilen \u00f6nemli koroner obstr\u00fcksiyonu olan hastalarda, model 1’in \u00f6nemli ay\u0131rt etme g\u00fcc\u00fcne sahip olmad\u0131\u011f\u0131 g\u00f6sterildi, ancak model 2 ve model 3 ile birle\u015ftirildi\u011finde tan\u0131sal g\u00fc\u00e7 artt\u0131 (s\u0131ras\u0131yla EAA 0.74 ve p <0.001 ve EAA 0.87, p <0.001 ). Ek olarak, ara\u015ft\u0131rmac\u0131lar, klasik farkl\u0131 derecelerde kalsiyum skorlar\u0131n\u0131 (1-10; 11-100; 101-400, 401-1000,> 1000) ve anjina, kalp at\u0131\u015f h\u0131z\u0131 ve aritmi tipi ile ili\u015fkisini de\u011ferlendirdiler. Bu fakt\u00f6rlerin her birinin kardiyak risk a\u00e7\u0131s\u0131ndan \u00f6nemi nedeniyle, ara\u015ft\u0131rmac\u0131lar KKS i\u00e7in daha fazla kardiyak tan\u0131 testi ihtiyac\u0131n\u0131 tahmin edebilecek tek bir kesme de\u011feri olmad\u0131\u011f\u0131n\u0131 ke\u015ffettiler. Bununla birlikte, ara\u015ft\u0131rmac\u0131lar her bir fakt\u00f6r\u00fc i\u00e7eren tablolar geli\u015ftirdiler ve bu tablolar ileri tan\u0131 testinin gerekip gerekmedi\u011fini belirlemeye yard\u0131mc\u0131 oldu. Bu \u00e7al\u0131\u015fmada baz\u0131 s\u0131n\u0131rlamalar vard\u0131r. \u00c7al\u0131\u015fma tasar\u0131m\u0131 retrospektifti ve veriler tek bir merkezden ve tek bir cihazdan elde edildi. Fraksiyonel ak\u0131m yede\u011fi dahil edilmedi ve ileri tan\u0131 testinin sonu\u00e7lar\u0131 \u00e7al\u0131\u015fma tasar\u0131m\u0131n\u0131n bir par\u00e7as\u0131 de\u011fildi.<\/p>\n

Genel olarak, ara\u015ft\u0131rmac\u0131lar, BTA\u2019dan \u00f6nce rutin KKS de\u011ferlendirmesinin, hastalar i\u00e7in daha ileri de\u011ferlendirmenin gerekli olup olmayaca\u011f\u0131na karar vermeye yard\u0131mc\u0131 olabilece\u011fi sonucuna vard\u0131lar.<\/p>\n

\u00a0<\/strong><\/p>\n

Geni\u015f Bir Radyasyon Doz Seviyesi Aral\u0131\u011f\u0131nda \u00c7ekilen Toraks BT’de Pulmoner Nod\u00fcllerin Saptanmas\u0131ndaki G\u00f6zlemci Performans\u0131<\/strong><\/span><\/h5>\n

Joel G. Fletcher , David L. Levin, Anne-Marie G. Sykes, Rebecca M. Lindell, Darin B. White, Ronald S. Kuzo, Vighnesh Suresh, Lifeng Yu, Shuai Leng, David R. Holmes III, Akitoshi Inoue, Matthew P. Johnson, Rickey E. Carter, Cynthia H. McCollough<\/p>\n

Radiology. 2020 Sep 29;200969<\/p>\n

Mayo Clinic\u2019ten ara\u015ft\u0131rmac\u0131lar 5 mm veya daha b\u00fcy\u00fck boyuttaki belirsiz pulmoner nod\u00fclleri (e\u011fer bir pulmoner nod\u00fclde kesin benign morfolojik bulgular yoksa belirsiz olarak s\u0131n\u0131fland\u0131r\u0131l\u0131r) de\u011ferlendirmek amac\u0131yla d\u00fc\u015f\u00fck doz radyasyon toraks BT\u2019si ile rutin doz radyasyon toraks BT\u2019sinin rol\u00fcn\u00fc ara\u015ft\u0131rmak istediler. Bu ara\u015ft\u0131rma, pulmoner nod\u00fcl de\u011ferlendirmesi i\u00e7in rutin doz toraks BT\u2019si \u00e7ekilen 83 hastay\u0131 i\u00e7eren retrospektif bir vaka kontrol \u00e7al\u0131\u015fmas\u0131yd\u0131. Rutin taramalar, 120 kV’de tek X-ray kayna\u011f\u0131 ve 70 kalite referans mAs (QRM), 0.5 saniye rotasyon s\u00fcresi ve 128 x 0.6-mm detekt\u00f6r konfig\u00fcrasyonunun otomatik poz kontrol ayar\u0131 ile yap\u0131ld\u0131. Daha sonra taramalar, orijinal g\u00f6r\u00fcnt\u00fcler kullan\u0131larak daha d\u00fc\u015f\u00fck doz veri setleri \u00fcretmek i\u00e7in filtrelenmi\u015f geri projeksiyon (FBP) veya yinelemeli rekonstr\u00fcksiyon (IR) i\u015flemlerinden ge\u00e7irildi. Genel olarak, ara\u015ft\u0131rmac\u0131lar, hasta ba\u015f\u0131na ve nod\u00fcl ba\u015f\u0131na hassasiyetin azalan radyasyon dozuyla birlikte d\u00fc\u015ft\u00fc\u011f\u00fcn\u00fc saptad\u0131. Ancak yeniden tasarlanm\u0131\u015f d\u00fc\u015f\u00fck radyasyon dozu (2.5 QRM) ve rutin doz(70 QRM) aras\u0131nda QRM’de 25 kat fark olmas\u0131na ra\u011fmen \u00f6zg\u00fcll\u00fc\u011f\u00fcn neredeyse de\u011fi\u015fmeden kald\u0131\u011f\u0131 g\u00f6zlemlendi. <\/strong>Buna ek olarak, ara\u015ft\u0131rmac\u0131lar 10 QRM’nin alt\u0131ndaki t\u00fcm doz konfig\u00fcrasyonlar\u0131nda subsolid nod\u00fcller i\u00e7in duyarl\u0131l\u0131\u011f\u0131n \u00f6nemli \u00f6l\u00e7\u00fcde azald\u0131\u011f\u0131n\u0131 g\u00f6sterdi (p <0.05). Daha d\u00fc\u015f\u00fck genel tan\u0131sal g\u00f6r\u00fcnt\u00fc kalitesi, g\u00f6r\u00fcnt\u00fcde daha fazla g\u00fcr\u00fclt\u00fc ve k\u00f6t\u00fcle\u015fen keskinlik dahil olmak \u00fczere azalan radyasyon dozu ile birlikte bir\u00e7ok sorun ortaya \u00e7\u0131kt\u0131.<\/p>\n

Ara\u015ft\u0131rman\u0131n genel sonu\u00e7lar\u0131, belirsiz pulmoner nod\u00fcller i\u00e7in BT\u2019den k\u00f6t\u00fc olmayan bir performans elde edebilmek i\u00e7in radyasyon dozunun rutin bir toraks BT’sinin 1\/7’si ve d\u00fc\u015f\u00fck doz tarama BT’sinin 1\/3’\u00fc kadar azalt\u0131labilabilece\u011fini g\u00f6stermektedir. Alternatif olarak,\u00a0 standart d\u00fc\u015f\u00fck doz tarama BT’sinin alt\u0131ndaki radyasyon dozu seviyelerinde k\u0131smi solid ve subsolid nod\u00fcllerin saptanmas\u0131nda d\u00fc\u015f\u00fc\u015f oldu\u011fu g\u00f6sterilmi\u015ftir. IR ile FBP kar\u015f\u0131la\u015ft\u0131rmas\u0131, IR’nin daha d\u00fc\u015f\u00fck dozlar i\u00e7in subjektif olarak daha iyi g\u00f6r\u00fcnt\u00fc kalitesine sahip oldu\u011funu g\u00f6sterdi, ancak veriler g\u00f6zlemci performans\u0131nda hi\u00e7bir fark g\u00f6stermedi. Konuyla ilgili daha fazla ara\u015ft\u0131rman\u0131n yap\u0131lmas\u0131 gerekimesine ra\u011fmen, y\u0131ll\u0131k taramalar i\u00e7in radyasyon dozunun daha da d\u00fc\u015f\u00fcr\u00fclmesinin uzun vadede fayda sa\u011flamas\u0131 muhtemeldir.<\/p>\n

\u00c7al\u0131\u015fman\u0131n s\u0131n\u0131rl\u0131l\u0131klar\u0131, aksiyal olmayan multiplanar reformatlar\u0131 incelemeyen s\u0131n\u0131rl\u0131 say\u0131da (3) okuyucuyla geriye d\u00f6n\u00fck bir vaka kontrol \u00e7al\u0131\u015fmas\u0131 tasar\u0131m\u0131n\u0131 i\u00e7erir. Uzman radyologlardan pratisyen hekimlere yap\u0131lan ekstrapolasyon da potansiyel bir s\u0131n\u0131rlamad\u0131r. Ayr\u0131ca kohort ger\u00e7ek pop\u00fclasyon prevalans\u0131n\u0131 yans\u0131tmayabilecek daha b\u00fcy\u00fck oranda subsolid nod\u00fcllere sahipti.<\/p>\n

 <\/p>\n

Akut Pulmoner Emboli Sonras\u0131 Kronik Tromboembolik Pulmoner Hipertansiyon Tahmini i\u00e7in BT Tabanl\u0131 Biyobelirte\u00e7ler<\/strong><\/span><\/h5>\n

Giovanni Lorenz, Mnahi Bin Saeedan, Jennifer Bullen, Frederikus A Klok, Lucia J M Kroft, Lilian J Meijboom, Gustavo A Heresi, Apichaya Sripariwuth, Rahul D Renapurkar<\/p>\n

American Journal of Roentgenology 2020 Oct;215(4):800-806.<\/p>\n

Cleveland Clinic, Hollanda’daki Leiden \u00dcniversitesi ve Tayland’daki Naresuan \u00dcniversitesi’nden ara\u015ft\u0131rmac\u0131lar, akut pulmoner emboli sonras\u0131 kronik tromboembolik pulmoner hipertansiyon (KTEPH) geli\u015fiminde BT tabanl\u0131 belirte\u00e7lerin rol\u00fcn\u00fc ve bunlar\u0131n tahmin de\u011ferini ara\u015ft\u0131rd\u0131. KTEPH, pulmoner hipertansiyonun (P-HTN) g\u00fcncellenmi\u015f klinik s\u0131n\u0131fland\u0131rmas\u0131nda grup 4 bozukluk olarak kategorize edilmi\u015ftir. KTEPH, tipik olarak pulmoner tromboendarterektomi ile tedavi edilebilir bir P-HTN formudur, ancak gecikme durumunda prognoz k\u00f6t\u00fcle\u015fti\u011fi ve perioperatif mortalite oran\u0131 artt\u0131\u011f\u0131 i\u00e7in erken tan\u0131 tedavide ba\u015far\u0131 i\u00e7in zorunludur. Bu \u00e7al\u0131\u015fma, KTEPH geli\u015ftiren hastalar\u0131 de\u011ferlendirmek i\u00e7in retrospektif olarak ger\u00e7ekle\u015ftirildi. Hastalar\u0131n ilk g\u00f6\u011f\u00fcs BT\u2019si nihai KTEPH geli\u015fimini \u00f6ng\u00f6rmek i\u00e7in belirte\u00e7lerin belirlenip belirlenemeyece\u011fini de\u011ferlendirmek i\u00e7in yeniden inceledi. Kronik PE belirtileri veya P-HTN’ye katk\u0131da bulunabilecek di\u011fer \u00f6nemli akci\u011fer hastal\u0131\u011f\u0131 olan hastalar \u00e7al\u0131\u015fmaya dahil edilmedi. Ana pulmoner arter, sol ve sa\u011f ana pulmoner arterler ve ayr\u0131ca 5 interlobar dalda tromb\u00fcs\u00fcn subjektif derecelendirilmesi yap\u0131ld\u0131. Dallar obstr\u00fcksiyon yok, k\u0131smi obstr\u00fcksiyon ve tam obstr\u00fcksiyon olarak derecelendirildi. De\u011ferlendirilen ek belirte\u00e7ler \u015funlard\u0131: Walsh skoru (segmental PA\u2019daki anormalliklerin kantitatif \u00f6l\u00e7\u00fcm\u00fc), sa\u011f ventrik\u00fcl \u00e7ap\u0131 (RVD), sol ventrik\u00fcl \u00e7ap\u0131 (LVD), RVD-LVD oran\u0131, RA \u00e7ap\u0131, PA \u00e7ap\u0131, sa\u011f kalp tromb\u00fcs\u00fc, perikardiyal ef\u00fczyon, akci\u011fer enfarkt\u00fcs\u00fc ve mozaik atten\u00fcasyon. Daha sonra bu belirte\u00e7lerin tek de\u011fi\u015fkenli analizi yap\u0131ld\u0131 ve \u00e7ok say\u0131da fakt\u00f6r\u00fcn KTEPH geli\u015fme olas\u0131l\u0131\u011f\u0131n\u0131 artt\u0131rd\u0131\u011f\u0131 g\u00f6sterildi. \u0130lk g\u00f6r\u00fcnt\u00fclemede t\u0131kay\u0131c\u0131 santral veya lober p\u0131ht\u0131, Walsh skoru, akci\u011fer enfarkt\u00fcs\u00fc ve mozaik atten\u00fcasyonun gelecekteki KTEPH geli\u015fimi ile ili\u015fkili oldu\u011fu bulundu (P <0.001). Perikardiyal ef\u00fczyon (P <0.017) da KTEPH geli\u015fimi ile ili\u015fkili bulundu. Ayr\u0131ca RVD-LVD oran\u0131, PA veya RA \u00e7ap\u0131 ve sa\u011f kalp tromb\u00fcs\u00fc gibi di\u011fer i\u015faretler, akut PE sonras\u0131 KTEPH geli\u015fimi ile hi\u00e7bir ili\u015fkiye sahip de\u011fildi.<\/p>\n

\u00c7al\u0131\u015fman\u0131n s\u0131n\u0131rl\u0131l\u0131klar\u0131, geriye d\u00f6n\u00fck bir tasar\u0131m ve belirli hastalar\u0131n \u00f6rnekleme dahil edilmemesinden kaynaklanan olas\u0131 se\u00e7im yanl\u0131l\u0131\u011f\u0131n\u0131 i\u00e7erir. \u00c7al\u0131\u015fmaya dahil edilen hastalar, potansiyel yanl\u0131l\u0131\u011fa neden olabilecek submasif\/masif PE’ye sahip PE yan\u0131t grubundand\u0131. BT’ye k\u0131yasla perf\u00fczyon kusurlar\u0131n\u0131 de\u011ferlendirmek i\u00e7in daha y\u00fcksek duyarl\u0131l\u0131\u011fa sahip ventilasyon-perf\u00fczyon taramalar\u0131 veya ek fonksiyonel testler de\u011ferlendirmeye kat\u0131lmad\u0131.<\/p>\n

Genel olarak, bu \u00e7al\u0131\u015fma BT tabanl\u0131 biyobelirte\u00e7lerin, akut PE sonras\u0131 KTEPH geli\u015fimi i\u00e7in daha y\u00fcksek risk alt\u0131nda olan hastalar\u0131n belirlenmesinde \u00f6nemli bir rol oynayabilece\u011fini g\u00f6stermektedir.<\/p>\n

 <\/p>\n

Translated by: Berk M\u0131zrak, Orhan Ula\u015f G\u00fcler, Duygu Cengiz<\/p>\n","protected":false},"excerpt":{"rendered":"Kalsiyum Skorlamas\u0131: Koroner BT anjiyografisine ek veya alternatif testlere olan ihtiyac\u0131 \u00f6ng\u00f6ren ki\u015fiselle\u015ftirilmi\u015f bir olas\u0131l\u0131k […]","protected":false},"author":3,"featured_media":7182,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[209],"tags":[],"class_list":["post-9686","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized-tr"],"yoast_head":"\nWhat's new in Cardiothoracic Imaging (Turkish) - November 2020 - ACORE<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/staging-hub.acoredu.com\/whats-new-in-cardiothoracic-imaging-november-2020\/\" \/>\n<meta property=\"og:locale\" content=\"tr_TR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"What's new in Cardiothoracic Imaging (Turkish) - 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