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van Noord D, Biermann K, Moons L M G, Pattynama P M T, Verhagen H J M, Kuipers E J & Mensink P B F (2010) Histopathology 57, 615-621 Histological changes in patients with chronic upper gastrointestinal ischaemia Aims: Diagnosing chronic upper gastrointestinal ischaemia (CUGI) remains a challenge in clinical practice. Histological examination of biopsy material currently plays no role in the diagnosis of transient CUGI, as little is known about gastrointestinal histology in these patients. The aim of this study was to investigate upper gastrointestinal histology in patients with well-defined CUGI. Methods and results: Consecutive patients suspected of CUGI were included prospectively and underwent a diagnostic work-up existing of upper endoscopy, gastrointestinal tonometry and computed tomography (CT) or magnetic resonance (MR) angiography. Results were discussed in a multidisciplinary team and a consensus diagnosis was made. Endoscopic biopsy samples were taken from the descending duodenum, gastric antrum and corpus, and scored using the Sydney, Vienna, Chiu, Marsh and Operative Link for Gastritis Assessment (OLGA) classifications. Gastropathy was scored present or absent. Seventy-nine patients were analysed in 8 months. CUGI was diagnosed in 41 patients (52%): 36 males, mean age 60 (17-86) years. Prevalence of gastropathy was significantly higher in patients with ischaemia ( P = 0.025). No other differences were found between patients with and without ischaemia. Conclusions: Histological examination of biopsy samples plays no definitive role in diagnosing CUGI, but the presence of histological signs of reactive gastropathy can be used to support the clinical diagnosis of ischaemia. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess pulmonary veins (PVs) for the presence of stenosis 3 months after cryothermal ablation (CA) with a new method of electrical isolation of PVs using contrast-enhanced 16 multidetector row computed tomography (MDCT). Twenty four patients with symptomatic atrial fibrillation underwent CA in 46 PVs. MDCT of PVs was performed before the treatment and after 3-months’ follow-up. Following cryoablation, 13/24 (54%) patients showed clinical improvement and had reduced attacks of atrial fibrillation. The dimensions of the treated PVs remained unchanged: the coronal ostial diameter was 19.1±2.4 preprocedural versus 18.6±2.4 mm at follow-up,p>0.05; the ratio of the coronal and axial diameters at the ostium was 1.2±0.2 versus 1.2±0.1,p>0.05, respectively, and the coronal diameter of the proximal 10 mm was 17.1±2.5 mm versus 16.5±2.2 mm,p>0.05, respectively. CA is a promising technique for electrical isolation of PVs that has not been associated with stenosis at the orifice and the proximal 10 mm of the PVs after 3-months’ follow-up. MDCT is a noninvasive, fast and comfortable method for assessment of PVs in a three-dimensional manner prior to ablative treatment and during the follow-up. [ABSTRACT FROM AUTHOR]

The aim of this study was to validate multislice computed tomography (MSCT) venography measurements of pulmonary vein (PV) diameters vs conventional pulmonary venography (CPV), and to assess the reproducibility of MSCT data. The study included 21 consecutive patients with atrial fibrillation who were planned for cryothermal ablation of PVs. One day before ablation, all patients underwent CPV and contrast-enhanced non-gated MSCT venography. The MSCT was repeated 3 months after ablation. The CPV images of the treated PVs ( n=40) were analyzed and compared with the results of MSCT measurements. Reproducibility of MSCT venography-based data was assessed by interobserver ( n=84 PVs) and interexamination ( n=44 PVs) variability. Pre-treatment PV diameters on MSCT and CPV showed good correlation ( r=0.87, p<0.01; 18.9+/-.2.3 mm, 188.5+/-.2.4 mm, respectively). Interobserver agreement and interexamination reproducibility were good ( r=0.91, r=0.82, respectively, p<0.01), with narrow limits of agreement (Bland and Altman method). The MSCT venography allows accurate and reproducible assessment of PVs. It can be used both in non-invasive planning of treatment for ablative therapy and in the follow-up of patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the usefulness of saline chaser in 16-row multislice CT (16-MSCT) coronary angiography. Forty-two patients were divided into two groups for contrast material (CM) administration: group 1 (140 ml at 4 ml/s) and group 2 (100 ml at 4 ml/s followed by 40 ml of saline chaser at 4 ml/s). All patients underwent retrospectively ECG-gated 16-MSCT coronary angiography. The attenuation at the origin coronary vessels was assessed. Three regions of interest (ROIs) were drawn throughout the data set: (a) ascending aorta (ROI 1); (b) descending aorta (ROI 2); and (c) pulmonary artery (ROI 3). The attenuation in the superior vena cava was recorded (ROI 4). The average attenuation and the slope were calculated in each ROI and differences were assessed with a Student's t test. The average attenuation in the coronary vessels was not significantly different in the two groups. The average attenuations in ROI 1 were 325 and 327 HU, in ROI 2 were 328 and 329 HU and in ROI 3 were 357 and 320 HU, for groups 1 and 2, respectively (p>0.05). The slopes in ROI 1 were -0.2 and 1.1, in ROI 2 were 2.8 and 2.1 (p>0.05) and in ROI 3 were 3.9 and -9.0 (p<0.05), for groups 1 and 2, respectively. The average attenuations in ROI 4 were 927 and 643 HU (p<0.05), for groups 1 and 2, respectively. One hundred milliliters of CM with 40 ml of saline chaser provides the same attenuation as 140 ml of CM (35% less) with decreased hyper-attenuation in the superior vena cava. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine and compare the effective dose of multidetector computed tomographic angiography (MDCT) and digital subtraction angiography (DSA) studies for diagnosing a pulmonary embolus (PE). Radiation exposure was measured as computed tomography dose index (MDCT) or as dose-area product (DSA) and was subsequently expressed in the quantity effective dose. Effective doses were obtained in 27 patients who underwent MDCT and in 12 patients who underwent DSA for suspected PE. The MDCT angiography was performed on a Siemens Volume Zoom CT scanner and DSA on a Philips Integris V-3000 system according to standardized protocols. Average effective dose for MDCT angiography of the pulmonary arteries (27 patients) was 4.2 mSv (range 2.2-6.0 mSv). Pulmonary DSA gained an average effective dose (12 patients) of 7.1 mSv (range 3.3-17.3 mSv). Our results show that the effective doses in MDCT angiography studies for PE are moderate and even slightly lower in comparison with pulmonary DSA in a comparable patient group. Variations in patient dose are smaller for MDCT, probably because this procedure can be more strictly protocolized. Patient dose should not be restrictive in the discussion of CTA replacing DSA for diagnosing PE. [ABSTRACT FROM AUTHOR]

Our objective was to evaluate, in a routine clinical setting, the role of spiral CT as a second procedure in patients with clinically suspected pulmonary embolism (PE) and abnormal perfusion scan. We prospectively studied the role of spiral CT in 279 patients suspected of PE. All patients started their diagnostic algorithm with chest radiographs and perfusion scintigraphy. Depending on the results of perfusion scintigraphy, patients proceeded to subsequent levels in the algorithm: stop if perfusion scintigraphy was normal; CT and pulmonary angiography if subsegmental perfusion defects were seen; ventilation scintigraphy followed by CT when segmental perfusion defects were seen; and pulmonary angiography in this last group when results of ventilation/perfusion scintigraphy and CT were incongruent. Reference diagnosis was based on normal perfusion scintigraphy, high probability perfusion/ventilation scintigraphy in combination with abnormal CT, or pulmonary angiography. If PE was present, the largest involved branch was noted on pulmonary angiography, or on spiral CT scan in case of a high-probability ventilation/perfusion scan and a positive CT scan. A distinction was made between embolism in a segmental branch or larger, or subsegmental embolism. Two hundred seventy-nine patients had abnormal scintigraphy. In 27 patients spiral CT and/or pulmonary angiography were non-diagnostic and these were excluded for image analysis. Using spiral CT we correctly identified 117 of 135 patients with PE, and 106 of 117 patients without PE. Sensitivity and specificity was therefore 87 and 91%, respectively. Prevalence of PE was 53%. Positive and negative predictive values were, respectively, 91 and 86%. In the high-probability group, sensitivity and specificity increased to 97 and 100%, respectively, with a prevalence of 90%. In the non-high probability-group sensitivity and specificity decreased to 61 and 89%, respectively, with a prevalence of 25%. In a routine clinical setting single-detector spiral CT technology has limited value as a second diagnostic test because of low added value in patients with a high-probability lung scan and low sensitivity in patients with non-high-probability lung scan result. [ABSTRACT FROM AUTHOR]