Search

The combination of coronary CT angiography and CT myocardial perfusion provides a promising opportunity for detailed and noninvasive coronary artery disease phenotyping, including characterization of ischemia without obstructive stenosis.

Combined CT angiography and CT myocardial perfusion enables similar prediction of 2-year major adverse cardiovascular event–free survival, including the need for myocardial revascularization procedures, similar to that achieved with standard invasive coronary angiography and single photon emission CT perfusion imaging.

With our methods, the lean body weight exhibited the strongest correlation with aortic and hepatic enhancement; therefore, we suggest it as the best body size index with which to determine the appropriate contrast medium dose at hepatic dynamic CT.

It is very important to assess the artery of Adamkiewicz before repair of the thoracoabdominal or descending thoracic aorta. Several studies have demonstrated the feasibility and advantages of noninvasive assessment of the artery of Adamkiewicz with magnetic resonance (MR) angiography and multi–detector row computed tomographic (CT) angiography. Recent advances in MR angiography and CT angiography have led to changes in the detectability of this artery. In the present study, both MR angiography and CT angiography were performed without complications for preoperative evaluation of 30 patients who underwent repair of the thoracoabdominal or descending thoracic aorta. MR angiography provided detection rates as high as 93% and 80% with the morphologic "hairpin turn" criterion and the anatomic "continuity" criterion, respectively. Sixteen–detector row CT angiography provided detection rates as high as 83% and 60%, respectively. Use of both MR angiography and CT angiography provided higher detection rates of 97% and 90%, respectively. The collateral pathways were depicted in seven cases (23%). MR angiography is superior for depiction of the artery of Adamkiewicz, especially when it arises from the false lumen of a dissecting aneurysm. CT angiography has a wide field of view and allows depiction of significant collateral pathways associated with the internal thoracic artery and intercostal arteries. © RSNA, 2006

An attempt was made to reduce the incidence of perioperative stroke by detecting cerebrovascular disease with preoperative head and neck magnetic resonance angiography and by selecting the coronary artery bypass grafting technique. This strategy was used in 268 patients with ischemic heart disease who had undergone both head and neck magnetic resonance angiography before elective coronary artery bypass in our hospital between May 1997 and April 2001. In patients with significant stenosis or obstruction detected by head and neck magnetic resonance angiography, the findings were evaluated and cerebral blood flow was examined using brain single-photon emission computed tomography. In those with a high risk of cerebrovascular ischemia, off-pump coronary artery bypass was performed to maintain cerebral blood flow. No stroke occurred during surgery, and hemodynamic cerebrovascular ischemia was prevented in all 268 patients. Postoperative stroke occurred in 3 patients (1.1%), but the incidence of perioperative stroke was reduced.

Gelatin-resorcin-formaldehyde (GRF) glue has been widely applied during operations for acute aortic dissection (AAD). At our institution, GRF glue was applied in 40 patients who underwent surgical procedures for AAD from 1995, two of whom needed a reoperation because of the development of a redissection and/or a pseudoaneurysm at the anastomotic sites. The operative findings and histological examinations suggested that the application of GRF glue during the initial operations might be related to the development of a redissection and/or a pseudoaneurysm.

Abstract

Purpose To determine whether the development of mid-term redissection after surgery for acute type A aortic dissection using gelatin-resorcin-formalin (GRF) glue could be prevented by applying less formalin. Methods Between 1995 and 1999, 59 patients underwent surgery with GRF glue to repair acute type A aortic dissection. Forty-one patients underwent surgery before October 1998, and 18 patients underwent surgery after November 1998. An excessive amount of formalin was used in the former period and less was used in the latter period. Results Follow-up computed tomography was done for 34 patients in the former period (Former group) and for 16 patients in the latter period (Latter group). This showed redissection in 19 of the 34 patients in the Former group and in 6 of the 16 patients in the Latter group. There was no significant difference in the frequency of mid-term redissection between the two groups. Conclusion The development of mid-term redissection of the aortic root was not prevented by applying less formalin in the GRF glue. Thus, we conclude that the cause of redissection is not entirely the result of too much formalin.

Abstract.: We encountered a case of severe symptomatic stenosis of the abdominal aorta after a surgical repair of an ascending aortic dissection. A 75-year-old woman underwent a reconstruction of the ascending aorta to treat a Stanford type A acute aortic dissection and cardiac tamponade. Eight hours postoperatively, the patient was anuric. An abdominal computed tomography scan revealed severe stenosis of the true lumen of the suprarenal abdominal aorta due to a dilatation of the false lumen. The patient's ischemic symptoms progressed to include a weakening femoral pulse and, as a result, an emergency right axillofemoral artery bypass was performed. We hypothesize that the stenosis of the true lumen of the abdominal aorta was secondary to the mechanical obstruction due to a false lumen, which already existed because of the thoracic dissection, and its size increased postoperatively as a consequence of uncontrolled postoperative hypertension.

Limb vessel vasodilation plays an important role in the regulation of skeletal muscle blood flow during exercise. However, little documentation is available that describes the vasodilatory response of peripheral vessels in patients with arteriosclerosis obliterans (ASO). This study investigates possible impairment of basal blood flow and response in ischemic and nonischemic legs of patients with ASO, and the effect of revascularization on leg hemodynamics.Basal calf blood flow and reactive hyperemic response to femoral occlusion were measured plethysmographically in 20 patients with unilateral ASO (20 stenotic legs and 20 nonstenotic legs) and eight healthy subjects (eight control legs). Eight stenotic legs underwent percutaneous transluminal angioplasty or surgical revascularization. Basal calf blood flow and peak hyperemic flow was significantly lower in stenotic and nonstenotic legs than in control legs. After revascularization, basal flow was unchanged in stenotic legs but elevated in nonstenotic legs (from 2.5 ±0.3 to 3.4 ±0. 4 mL/min/dL tissue, p<0.01). Peak flow in both legs was significantly elevated (stenotic legs, from 12.8 ± 1.9 to 17.6 ± 1.6 mL/min/dL tissue, p<0.01; nonstenotic legs, from 14.3 ± 1.0 to 20.0 ±1.6 mL/min/dL tissue, p<0.01), although still below control values.Basal blood flow and maximum vasodilatory response of resistance vessels are impaired irrespective of the side of conduit vessel involvement. The vascular response of the nonstenotic side is significantly enhanced after revascularization of the contralateral stenotic lesions. These suggest that neural or circulating vasoacting factor(s) originating from the stenotic limb may contribute to peripheral circulatory disturbance in claudicants.

Summary: This manuscript presents an unusual radiographic manifestation of multiple myeloma occurring in the mandible. A 40-year-old man, referred to our hospital, presented with a swelling of the right mandible. Microscopic examination and laboratory tests confirmed the diagnosis of multiple myeloma. Radiographic examination revealed a well-developed sun-ray appearance suspected in osteogenic sarcoma. This observation suggested the possibility of the periosteal reaction in this case of multiple myeloma.

A Japanese male infant with lissencephaly, congenital muscular dystrophy (CMD), and ocular abnormalities is described. This patient represents features of the cerebro-oculo-muscular syndrome. Cranial computerized tomography revealed diffuse agyria, low density of the white matter, and hypoplasia of the cerebellar vermis. Brain histology suggested type II lissencephaly. These findings are correlated with other similar conditions, such as Walker-Warburg syndrome, Fukuyama-type CMD, and muscle, eye and brain disease.

ObjectiveTo determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients.DesignProspectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies.Data sourcesMedline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators.Eligibility criteria for selecting studiesProspective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2×2 or 3×2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups.ResultsIndividual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were obtained using CTA. At a pretest probability of 7%, the positive predictive value of CTA was 50.9% (95% confidence interval 43.3% to 57.7%) and the negative predictive value of CTA was 97.8% (96.4% to 98.7%); corresponding values at a pretest probability of 67% were 82.7% (78.3% to 86.2%) and 85.0% (80.2% to 88.9%), respectively. The overall sensitivity of CTA was 95.2% (92.6% to 96.9%) and the specificity was 79.2% (74.9% to 82.9%). CTA using more than 64 detector rows was associated with a higher empirical sensitivity than CTA using up to 64 rows (93.4% v86.5%, P=0.002) and specificity (84.4% v72.6%, P<0.001). The area under the receiver-operating-characteristic curve for CTA was 0.897 (0.889 to 0.906), and the diagnostic performance of CTA was slightly lower in women than in with men (area under the curve 0.874 (0.858 to 0.890) v0.907 (0.897 to 0.916), P<0.001). The diagnostic performance of CTA was slightly lower in patients older than 75 (0.864 (0.834 to 0.894), P=0.018 vall other age groups) and was not significantly influenced by angina pectoris type (typical angina 0.895 (0.873 to 0.917), atypical angina 0.898 (0.884 to 0.913), non-anginal chest pain 0.884 (0.870 to 0.899), other chest discomfort 0.915 (0.897 to 0.934)).ConclusionsIn a no-treat/treat threshold model, the diagnosis of obstructive CAD using coronary CTA in patients with stable chest pain was most accurate when the clinical pretest probability was between 7% and 67%. Performance of CTA was not influenced by the angina pectoris type and was slightly higher in men and lower in older patients.Systematic review registrationPROSPERO CRD42012002780.