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Davidson C, Holihan C, de Oliveira Sillero R, Lee K, Mitchell RB, Shah G. Infectious Pseudoaneurysm of the Internal Carotid Artery in a Child Secondary to Parapharyngeal Abscess. EAR, NOSE & THROAT JOURNAL 2023; 102:NP31-NP34. [PMID: 33393822 DOI: 10.1177/0145561320984582] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Infectious pseudoaneurysm is a rare condition characterized by arterial wall dilation, usually due to an adjacent infectious focus. We present an 8-year-old male with a 3-day history of progressive, severe headache 2 weeks after treatment for a parapharyngeal abscess. Computed tomography revealed a left internal carotid artery (ICA) pseudoaneurysm inferior to the skull base and a small parapharyngeal abscess inferior to the pseudoaneurysm. The patient was admitted for intravenous antibiotic treatment and underwent transfemoral endovascular coil occlusion of the cervical ICA pseudoaneurysm without complications. We discuss the presentation and management of rare vascular complications of parapharyngeal abscesses involving major arteries of the neck and the role of neurointerventional embolization in these cases.
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Affiliation(s)
| | - Cheryl Holihan
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Kenneth Lee
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ron B Mitchell
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gopi Shah
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Beller E, Ammermann F, Busse A, Heller T, Thierfelder KM, Weinrich M, Neumann A, Weber MA, Meinel FG. Extravascular findings on run-off MR angiography: frequency, location and clinical significance. Clin Imaging 2020; 69:172-178. [PMID: 32861128 DOI: 10.1016/j.clinimag.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/03/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the prevalence, location and clinical relevance of extravascular findings (EVFs) on magnetic resonance angiography (MRA) of the run-off vasculature. METHODS In this retrospective study, we analyzed run-off MRAs of 194 consecutive patients (45 women and 149 men, median age 68 years, IQR 58-74 years). Our patient cohort consisted predominantly of individuals with known (n = 165, 85%) or suspected (n = 15, 8%) peripheral artery disease (PAD). All MRA examinations were performed between 2012 and 2018 on a 3 Tesla MRI scanner using a standardized protocol. Two radiologists re-evaluated the MRA images to identify EVFs, which were classified into findings with major (category I), moderate (category II) and minor (category III) clinical significance. RESULTS A total of 501 EVFs were found in 172 of the 194 patients (89%). Twenty-seven findings (5%) were assigned to category I, 189 (38%) to category II and 285 (57%) to category III. 23 of 194 patients (12%) had at least one EVF with major clinical relevance (category I). Most of the 27 category I EVFs were observed in the soft tissues (n = 13, 48%). The remaining category I EVFs were found in the musculoskeletal (n = 7, 26%), urogenital (n = 4, 15%), lymphatic (n = 2, 7%) and gastrointestinal (n = 1, 4%) system. The majority of the category I EVFs were infectious (n = 14, 52%) or neoplastic (n = 10, 37%) pathologies. CONCLUSIONS Clinically relevant EVF can be encountered frequently on run-off MRA examinations. These results illustrate the importance of evaluating all organ systems when reporting MRA examinations, despite the clinical focus being the patients' vascular status.
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Affiliation(s)
- Ebba Beller
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany.
| | - Felix Ammermann
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Anke Busse
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Thomas Heller
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Kolja M Thierfelder
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Malte Weinrich
- Department of General, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, Rostock, Germany
| | - Andreas Neumann
- Department of General, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
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Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2019; 57:165-198. [DOI: 10.1016/j.ejvs.2018.09.016] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Bisla JK, Saranathan M, Martin DR, Arif-Tiwari H, Kalb BT. MR Imaging Evaluation of the Kidneys in Patients with Reduced Kidney Function. Magn Reson Imaging Clin N Am 2019; 27:45-57. [DOI: 10.1016/j.mric.2018.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Czerny M, Schmidli J, Adler S, van den Berg JC, Bertoglio L, Carrel T, Chiesa R, Clough RE, Eberle B, Etz C, Grabenwöger M, Haulon S, Jakob H, Kari FA, Mestres CA, Pacini D, Resch T, Rylski B, Schoenhoff F, Shrestha M, von Tengg-Kobligk H, Tsagakis K, Wyss TR, Debus S, de Borst GJ, Di Bartolomeo R, Lindholt J, Ma WG, Suwalski P, Vermassen F, Wahba A, von Ballmoos MCW. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg 2019; 55:133-162. [PMID: 30312382 DOI: 10.1093/ejcts/ezy313] [Citation(s) in RCA: 281] [Impact Index Per Article: 56.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Jürg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sabine Adler
- Department for Rheumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jos C van den Berg
- Department of Radiology, Centro Vascolare Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland.,Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Bertoglio
- Division of Vascular Surgery, "Vita salute" University, Ospedale San Raffaele, Milan, Italy
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roberto Chiesa
- Division of Vascular Surgery, "Vita salute" University, Ospedale San Raffaele, Milan, Italy
| | - Rachel E Clough
- Division of Imaging Sciences and Biomedical Engineering, St Thomas' Hospital, King's College London, London, UK
| | - Balthasar Eberle
- Department for Anesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Etz
- Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | | | - Stephan Haulon
- Aortic Center, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis-Robinson, France
| | | | - Fabian A Kari
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Carlos A Mestres
- University Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Timothy Resch
- Department of Vascular Surgery, Vascular Center Skåne University Hospital, Malmö, Sweden
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Malakh Shrestha
- Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Hendrik von Tengg-Kobligk
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Thomas R Wyss
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Francois CJ, Skulborstad EP, Majdalany BS, Chandra A, Collins JD, Farsad K, Gerhard-Herman MD, Gornik HL, Kendi AT, Khaja MS, Lee MH, Sutphin PD, Kapoor BS, Kalva SP. ACR Appropriateness Criteria ® Abdominal Aortic Aneurysm: Interventional Planning and Follow-Up. J Am Coll Radiol 2018; 15:S2-S12. [DOI: 10.1016/j.jacr.2018.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/17/2022]
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Sohns JM, Menke J, Bergau L, Weiss BG, Schmuck S, Weiberg D, Staab W, Derlin T, Dorenkamp M, Sohns C. Extra-vascular findings in patients undergoing magnetic resonance angiography of the abdomen, pelvis and lower extremities: A retrospective study of 352 patients. Vascular 2017; 26:27-38. [DOI: 10.1177/1708538117714401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The aim of this study was to assess the prevalence and clinical significance of extra-vascular findings in patients undergoing magnetic resonance angiography of the abdomen, pelvis and lower extremities. Materials and methods Three hundred fifty-two patients underwent abdominal, pelvic and lower extremity 1.5 T magnetic resonance angiography. Clinically relevant vascular and extra-vascular findings were identified. Relevant vascular findings were classified as stenosis, occlusion, aneurysm, sclerosis, dissection or vasculitis. Relevant extra-vascular findings were categorized as ‘safe’ (Group A), intermediate – requiring additional investigation – (Group B) and malignant/endangering – requiring change of therapy (Group C). Results A total of 2152 clinically relevant vascular findings was identified (6.1/patient). The most frequent vascular finding was femoral artery stenosis (10.6%). Four hundred fifty-one extra-vascular findings were observed (1.3/patient) and classified into Group A (78%), Group B (19.5%) and Group C findings (2.4%). The most frequent malignant findings were lung cancer, lymphoma, osteosarcoma, hepatocellular carcinoma and renal cell carcinoma (7/352 patients). Conclusions Extravascular findings are frequently encountered in magnetic resonance angiography performed for vascular indications. Clinically relevant findings are seen in a substantial part of patients and should prompt further diagnostic work-up.
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Affiliation(s)
- Jan M Sohns
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
- German Center for Cardiovascular Research, DZHK, Berlin, Germany
| | - Jan Menke
- Institute for Diagnostic and Interventional Radiology, Georg-August University, UMG, Göttingen, Germany
| | - Leonard Bergau
- German Center for Cardiovascular Research, DZHK, Berlin, Germany
- Department of Cardiology and Pneumology, Georg-August University, UMG, Göttingen, Germany
| | - Bernhard G Weiss
- Department of Otorhinolaryngology-Head and Neck Surgery, Georg-August University, UMG, Göttingen, Germany
| | - Sebastian Schmuck
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
| | - Desiree Weiberg
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
| | - Wieland Staab
- German Center for Cardiovascular Research, DZHK, Berlin, Germany
- Institute for Diagnostic and Interventional Radiology, Georg-August University, UMG, Göttingen, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, MHH, Hannover, Germany
| | - Marc Dorenkamp
- Department of Medicine, Cardiology Division, Charité Campus Virchow Klinikum, Berlin, Germany
| | - Christian Sohns
- Electrophysiology Bremen, Heart Center Bremen, Am Klinikum Links der Weser, Bremen, Germany
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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Olin JW, Jang J, Jaff MR, Beckman JA, Rooke T. Vascular Imaging: An Unparalleled Decade. J Endovasc Ther 2016; 11 Suppl 2:II21-31. [PMID: 15760260 DOI: 10.1177/15266028040110s618] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vascular imaging techniques, such as catheter angiography, ultrasound, computed tomography (CT), and magnetic resonance (MR), have all undergone unprecedented innovation and incredible technological leaps in the last 10 years. Ultrasound, CT, and MR have progressed in acquisition speed, resolution, and accuracy to the point that they have now supplanted the former mainstay, invasive catheter-based angiography, despite the advent of digitized angiographic image recording. This review explores the advantages and shortcomings of each technique and how they have changed the diagnosis and assessment of the cardiovascular system for endovascular intervention.
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Affiliation(s)
- Jeffrey W Olin
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Suttmeyer B, Teichgräber U, Thomas A, Rathke H, Albrecht L, Jonczyk M, Verba M, Güttler F, Schnackenburg B, Hamm B, de Bucourt M. Non-invasive ECG-triggered 2D TOF MR angiography of the pelvic and leg arteries in an open 1.0-tesla high-field MRI system in comparison to conventional DSA. ACTA ACUST UNITED AC 2015; 59:29-37. [PMID: 24334421 DOI: 10.1515/bmt-2013-0113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 11/20/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES A non-contrast-enhanced 2D time-of-flight magnetic resonance angiography (TOF-MRA) protocol was compared with the gold standard of planar digital subtraction angiography (DSA) by calculating correlations of vessel diameters. METHODS A total of 1134 vascular diameters in 81 corresponding sites were prospectively measured by TOF-MRA and DSA in seven patients (four women, three men; mean age, 68 years). For a total of 162 vascular segments per patient, 81 Spearman's ρ correlation coefficients were calculated, consolidated to 41 due to consideration of symmetry (right/left), and assessed by correlation quality. RESULTS In the 41 consolidated segments, correlations were good, very good, and excellent in 25 segments (n=10>0.5, n=4>0.7, and n=11>0.8), moderate to poor in seven segments (n=4>0.3 and 0<n=3≤0.3), without in two, inverse in three, and nonmeasurable in four segments. Correlations were best for the main arteries above the knee, and these arteries were most consistently visualized. CONCLUSION The TOF-MRA protocol presented here can be performed in an open 1.0-T MRI system in 60-90 min. Visualization is degraded when the target artery leaves the plane orthogonal to the imaging plane (1) or signal yield is poor due to small caliber (2).
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Magnetic resonance angiography of the pediatric abdomen and pelvis: techniques and imaging findings. Magn Reson Imaging Clin N Am 2013; 21:843-60. [PMID: 24183529 DOI: 10.1016/j.mric.2013.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although traditional catheter-based angiography has been the gold standard for pediatric abdominal and pelvic vascular imaging for the past several decades, advances in magnetic resonance angiography (MRA) have made it a viable alternative. MRA offers several advantages in that it is noninvasive, can be performed without ionizing radiation, and does not necessarily rely on contrast administration. The ability of modern MRA techniques to define variant vascular anatomy and detect vascular disease may obviate traditional angiography in some patients.
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Mensel B, Kühn JP, Schneider T, Quadrat A, Hegenscheid K. Mean thoracic aortic wall thickness determination by cine MRI with steady-state free precession: validation with dark blood imaging. Acad Radiol 2013; 20:1004-8. [PMID: 23830606 DOI: 10.1016/j.acra.2013.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 03/14/2013] [Accepted: 03/20/2013] [Indexed: 10/26/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the validity and reliability of measuring mean aortic wall thickness (MAWT) of the ascending and descending aorta using cine steady-state free precession (SSFP) imaging compared to dark blood (DB) imaging. MATERIALS AND METHODS DB and SSFP images of the thoracic aorta acquired at 1.5 T in 50 volunteers (26 women, 24 men; mean age: 50.2 ± 13.1 years) were used. MAWT was calculated on DB and SSFP images for the ascending and descending aorta at the level of the right pulmonary artery by two independent observers. Validity was assessed using Bland-Altman analysis, Passing-Bablok regression, and Spearman correlation. Reliability was assessed using Bland-Altman analysis and intraclass coefficients (ICCs). RESULTS The mean MAWT of the ascending aorta on DB and SSFP images was 1.89 ± 0.21 mm and 1.87 ± 0.20 mm. The measurements for the descending aorta were 1.60 ± 0.22 and 1.63 ± 0.20 mm, respectively. Comparison of DB and SSFP measurements revealed a mean bias of 1.3% (95% limits of agreement (LOA): -7.9, 10.5%) for the ascending and of -2.1% (LOA: -10.5, 6.3%) for the descending aorta. The corresponding regression equation was y = 0.042 + 0.960 × (r = 0.91; P < .0001) and y = 0.118 + 0.939 × (r = 0.95; P < .0001), respectively. Intra- and interobserver variability showed a mean bias of less than 2.0% and LOA of less than ±15.0%. ICCs were greater than or equal to 0.85. CONCLUSIONS MAWT determination in the ascending and descending aorta using cine SSFP sequences is highly valid and reliable compared to DB imaging.
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Uncommon congenital extracardiac vascular anomalies detected on MSCT (Multi-Slice Computed Tomography) aortic angiography with 64-multislice technology. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2012. [DOI: 10.1016/j.ejrnm.2011.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Shah DJ, Lim TH. Evaluation of meglumine gadoterate-enhanced MR angiography (MRA) compared with time-of-flight MRA in the diagnosis of clinically significant non-coronary arterial disease: a pooled analysis of data from two clinical trials. Br J Radiol 2011; 85:596-605. [PMID: 22167518 DOI: 10.1259/bjr/16406056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES We analysed pooled data from two clinical trials to assess the diagnostic accuracy and safety of meglumine gadoterate (Gd-DOTA)-enhanced MR angiography (MRA) relative to those of non-enhanced time-of-flight (TOF) MRA for non-coronary arterial disease. Both techniques were compared with X-ray angiography as the gold standard. METHODS Patients were of both sexes, were aged at least 18 years and had suspected non-coronary arterial disease. Each patient was his/her own control and underwent TOF MRA followed by Gd-DOTA-enhanced MRA, and then X-ray angiography. MRA was performed at 1.5 T (USA study) or 3 T (Republic of Korea study). The primary criterion used to evaluate efficacy was the degree to which the MRA examination agreed with X-ray angiography in assessing non-coronary arterial lesions. The performance of Gd-DOTA over TOF was assessed using a one-sided paired t-test. We also evaluated the specificity, sensitivity, image quality, examination duration and clinical safety of both MRA procedures. RESULTS In total, 192 patients were enrolled and received Gd-DOTA. In the intent-to-treat population (n=162), within-patient accuracy was significantly greater for Gd-DOTA than for TOF (85.8 ± 19.8% agreement between Gd-DOTA and X-ray angiography compared with 78.3 ± 24.9% agreement between TOF and X-ray angiography; p=0.0001). The sensitivity, specificity, image quality and examination duration were also better for Gd-DOTA than for TOF. There were no serious drug-related adverse events. CONCLUSION We conclude that Gd-DOTA-enhanced MRA is a safe and accurate procedure for detecting arterial stenosis at both 1.5 T and 3 T.
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Affiliation(s)
- D J Shah
- Cardiac Magnetic Resonance Imaging, Weill Cornell Medical College, The Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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Morita S, Masukawa A, Suzuki K, Hirata M, Kojima S, Ueno E. Unenhanced MR Angiography: Techniques and Clinical Applications in Patients with Chronic Kidney Disease. Radiographics 2011; 31:E13-33. [DOI: 10.1148/rg.312105075] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Achenbach M, Figiel JH, Burbelko M, Heverhagen JT. Prospective comparison of image quality and diagnostic accuracy of 0.5 molar gadobenate dimeglumine and 1.0 molar gadobutrol in contrast-enhanced run-off magnetic resonance angiography of the lower extremities. J Magn Reson Imaging 2011; 32:1166-71. [PMID: 21031523 DOI: 10.1002/jmri.22355] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To compare image quality and diagnostic accuracy of 0.5 molar gadobenate dimeglumine and 1.0 molar gadobutrol in contrast-enhanced (CE) magnetic resonance angiography (MRA) of the lower extremities interindividually. MATERIALS AND METHODS The study was approved by our Institutional Review Board. Written informed consent was obtained from all patients before enrollment in the study. We prospectively included 74 patients (21 women, 53 men; mean age ± SD: 67.9 ± 11.0 years) with suspected peripheral occlusive vascular disease. All patients underwent a contrast-enhanced MRA of both lower extremities with either 0.1 mL/kg body weight gadobutrol or gadobenate dimeglumine. Image quality, stenosis grade, and artifacts were assessed by two blinded, independent investigators. Signal intensity (SI), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured by a third investigator. Contrast agent groups were compared to each other using a two-sided Student's t-test. RESULTS The results did not show significant differences for SI, SNR, or CNR. Both investigators were in significant accordance (P < 0.05) with regard to stenosis detection. CONCLUSION We conclude that application of standard clinical doses (0.1 mL/kg body weight) of both contrast agents provides similar diagnostic results and gadolinium dose could be reduced by the application of a single dose of gadobenate dimeglumine for CE run-off MRA.
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Affiliation(s)
- Marina Achenbach
- Department of Diagnostic Radiology, Philipps University Marburg, University Hospital Giessen and Marburg GmbH, Marburg, Germany
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Sharma P, Kalb B, Kitajima HD, Salman KN, Burrow B, Ray GL, Martin DR. Optimization of single injection liver arterial phase gadolinium enhanced MRI using bolus track real-time imaging. J Magn Reson Imaging 2011; 33:110-8. [PMID: 21182128 DOI: 10.1002/jmri.22200] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To measure contrast agent enhancement kinetics in the liver and to further evaluate and develop an optimized gadolinium enhanced MRI using a single injection real-time bolus-tracking method for reproducible imaging of the transient arterial-phase. MATERIALS AND METHODS A total of 18 subjects with hypervascular liver lesions were imaged with four dimensional (4D) perfusion scans to measure time-to-peak (TTP) delays of arterial (aorta-celiac axis), liver parenchyma, liver lesion, portal, and hepatic veins. Time delays were calculated from the TTP-aorta signal, and then related to the gradient echo (GRE) k-space acquisition design, to determine optimized timing for real-time bolus-track triggering methodology. As another measure of significance, 200 clinical patients were imaged with 3D-GRE using either a fixed time-interval or by individualized arterial bolus real-time triggering. Bolus TTP-aorta was calculated and arterial-phase acquisitions were compared for accuracy and reproducibility using specific vascular enhancement indicators. RESULTS The mean bolus transit-time to peak-lesion contrast was 8.1 ± 2.7 seconds following arterial detection, compared to 32.1 ± 5.4 seconds from contrast injection, representing a 62.1% reduction in the time-variability among subjects (N = 18). The real-time bolus-triggered technique more consistently captured the targeted arterial phase (94%), compared to the fixed timing technique (73%), representing an expected improvement of timing accuracy in 28% of patients (P = 0.0001389). CONCLUSION Our results show detailed timing window analysis required for optimized arterial real-time bolus-triggering acquisition of transient arterial phase features of liver lesions, with optimized arterial triggering expected to improve reproducibility in a significant number of patients.
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Affiliation(s)
- Puneet Sharma
- Department of Radiology, Emory Healthcare, Inc., Atlanta, Georgia, USA
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Abstract
Acute lower abdominal and pelvic pain is a frequent complaint of patients in the emergency room. Usually, the condition of these patients is assessed with computed tomography (CT) and ultrasonography (US). However, the need to reduce radiation doses of as much as 20 mSv at CT, especially in younger patients and possibly pregnant patients, and the operator dependence of US have led to an increased use of magnetic resonance (MR) imaging to assess those patients. MR imaging shows high accuracy in these patients and can be used to establish an accurate diagnosis quickly and reliably. A short imaging protocol of about 10 minutes, without the use of an intravenous contrast agent in most cases, allows investigation of these patients. The basic imaging protocol that localizes the diseased anatomic region needs to be complemented by focused anatomic imaging of the diseased area. Although MR imaging might not be the modality of choice for all patients, it may be beneficial for a subset of patients for whom CT is not warranted (pregnant patients or young patients) and US findings are inconclusive. In patients with acute abdominal and pelvic pain, the range of diseases and disorders that can be diagnosed with MR imaging is extremely broad. Therefore, MR imaging should be considered as an excellent imaging modality for the evaluation of these patients.
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Affiliation(s)
- Johannes T Heverhagen
- Department of Diagnostic Radiology, Philipps University Marburg, University Hospital Giessen and Marburg, Baldinger Strasse, 35033 Marburg, Germany.
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Rybicki FJ, Nallamshetty L, Yucel EK, Holtzman SR, Baum RA, Foley WD, Ho VB, Mammen L, Narra VR, Stein B, Moneta GL. ACR Appropriateness Criteria® on Recurrent Symptoms Following Lower-Extremity Angioplasty. J Am Coll Radiol 2008; 5:1176-80. [DOI: 10.1016/j.jacr.2008.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Indexed: 11/24/2022]
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21
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Korosoglou G, Shah S, Vonken EJ, Gilson WD, Schär M, Tang L, Kraitchman DL, Boston RC, Sosnovik DE, Weiss RG, Weissleder R, Stuber M. Off-resonance angiography: a new method to depict vessels--phantom and rabbit studies. Radiology 2008; 249:501-9. [PMID: 18780823 DOI: 10.1148/radiol.2491071706] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the utility of inversion recovery with on-resonant water suppression (IRON) in combination with injection of the long-circulating monocrystalline iron oxide nanoparticle (MION)-47 for contrast material-enhanced magnetic resonance (MR) angiography. MATERIALS AND METHODS Experiments were approved by the institutional animal care committee. Eleven rabbits were imaged at baseline before injection of a contrast agent and then serially 5-30 minutes, 2 hours, 1 day, and 3 days after a single intravenous bolus injection of 80 micromol of MION-47 per kilogram of body weight (n = 6) or 250 micromol/kg MION-47 (n = 5). Conventional T1-weighted MR angiography and IRON MR angiography were performed on a clinical 3.0-T imager. Signal-to-noise and contrast-to-noise ratios were measured in the aorta of rabbits in vivo. Venous blood was obtained from the rabbits before and after MION-47 injection for use in phantom studies. RESULTS In vitro blood that contained MION-47 appeared signal attenuated on T1-weighted angiograms, while characteristic signal-enhanced dipolar fields were observed on IRON angiograms. In vivo, the vessel lumen was signal attenuated on T1-weighted MR angiograms after MION-47 injection, while IRON supported high intravascular contrast by simultaneously providing positive signal within the vessels and suppressing background tissue (mean contrast-to-noise ratio, 61.9 +/- 12.4 [standard deviation] after injection vs 1.1 +/- 0.4 at baseline, P < .001). Contrast-to-noise ratio was higher on IRON MR angiograms than on conventional T1-weighted MR angiograms (9.0 +/- 2.5, P < .001 vs IRON MR angiography) and persisted up to 24 hours after MION-47 injection (76.2 +/- 15.9, P < .001 vs baseline). CONCLUSION IRON MR angiography in conjunction with superparamagnetic nanoparticle administration provides high intravascular contrast over a long time and without the need for image subtraction.
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Affiliation(s)
- Grigorios Korosoglou
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Holden A, Merrilees S, Mitchell N, Hill A. Magnetic resonance imaging of popliteal artery pathologies. Eur J Radiol 2008; 67:159-68. [PMID: 17765423 DOI: 10.1016/j.ejrad.2007.06.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2006] [Revised: 06/17/2007] [Accepted: 06/20/2007] [Indexed: 11/19/2022]
Abstract
This paper illustrates examples of popliteal artery pathologies imaged with contrast enhanced magnetic resonance angiography (CE-MRA) and magnetic resonance imaging (MRI) at a single tertiary referral centre. Popliteal artery pathologies were identified in 1710 patients referred over a 6-year period with symptoms suggesting lower limb arterial occlusive disease. Common pathologies such as atherosclerotic occlusive disease, thromboemboli and aneurysm disease are discussed as well as unusual pathologies such as cystic adventitial disease, mycotic aneurysm and arterial entrapment. The combination of CE-MRA and the excellent soft tissue resolution of MRI allow detailed evaluation of arterial and peri-arterial pathologies, and facilitate appropriate management decisions.
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Affiliation(s)
- Andrew Holden
- Department of Radiology, Auckland City Hospital, Park Road, Grafton, Auckland 9, New Zealand.
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23
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Abstract
Diseases of the aorta are imaged using different modalities according to the cause and clinical situation. Current imaging strategies for the clinically most pertinent aortic diseases are analysed. These disease entities may be differentiated into congenital, acquired and inflammatory diseases. Traumatic and non-traumatic aortic aneurysms and dissections are emphasised in context with endovascular treatment options and subsequent follow-up.
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Affiliation(s)
- P Reimer
- Radiologie Gefässzentrum Karlsruhe, Klinikum Karlsruhe, Akademisches Lehrkrankenhaus der Universität Freiburg, Moltkestrasse 90, 76133, Karlsruhe, Germany.
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24
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Papp DF, Khanna AJ, McCarthy EF, Carrino JA, Farber AJ, Frassica FJ. Magnetic resonance imaging of soft-tissue tumors: determinate and indeterminate lesions. J Bone Joint Surg Am 2007; 89 Suppl 3:103-15. [PMID: 17908876 DOI: 10.2106/jbjs.g.00711] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Derek F Papp
- Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224-2780, USA
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25
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Abstract
Recent advances in noninvasive imaging methods, such as CT and MR imaging, have replaced most of invasive angiographic procedures in the diagnosis of acquired aortic disease, decreasing the cost and morbidity of diagnosis. This article reviews and illustrates present MR imaging methods for evaluation of the aorta. Common diseases of the aorta also are discussed with a focus on their unique morphologic and functional features and characteristic MR imaging findings. Knowledge of pathologic conditions of common aortic diseases and proper MR imaging techniques enables accurate and time-efficient aortic evaluation.
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Affiliation(s)
- Ichiro Sakamoto
- Department of Radiology and Radiation Biology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
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26
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Morita S, Kimura T, Masukawa A, Saito N, Suzuki K, Mitsuhashi N. Flow direction of ascending lumbar veins on magnetic resonance angiography and venography: would "descending lumbar veins" be a more precise name physiologically? ACTA ACUST UNITED AC 2006; 32:749-53. [PMID: 17151894 DOI: 10.1007/s00261-006-9166-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Physiological flow direction of ascending lumbar vein (ALV) is not well recognized. METHODS Two-dimensional time-of-flight magnetic resonance angiography (MRA) examinations of the lower extremities in 44 patients and venography (MRV) in 59 patients were retrospectively reviewed. chi2 analysis was used to compare the frequency of ALV detection between the MRA and MRV groups and between cases with filling defects above the ALV confluence and other cases in the MRV group. RESULTS Frequency of ALV detection was significantly higher in the MRA group (60 of 88 veins, 68.2%) than in the MRV group (9 of 118 veins, 7.6%, P < 0.0001) and in cases with filling defects above the ALV confluence (8 of 23 veins, 34.8%; 6 were compression of the left common iliac vein by the right common iliac artery, 2 were thrombus of the proximal bilateral common iliac veins) than in other cases (1 of 95 veins, 1.1%) in the MRV group (P < 0.0001). CONCLUSIONS Without compression or occlusion above the ALV confluence, the general flow direction of the ALVs is not ascending but descending, suggesting that "descending lumbar veins" is a more physiologically precise name for these veins than ALVs.
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Affiliation(s)
- Satoru Morita
- Department of Radiology, Saiseikai Kurihashi Hospital, 714-6, Gotanda, Kouemon, Kurihashi-Machi, Kitakatsushika-Gun, Saitama, 349-1105, Japan.
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Biron A, Berkowitz RG, Bekhit EK, Rose EAM. Ultrasound diagnosis of an internal carotid artery pseudoaneurysm in a young child. Int J Pediatr Otorhinolaryngol 2006; 70:1975-9. [PMID: 16949680 DOI: 10.1016/j.ijporl.2006.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 06/12/2006] [Accepted: 06/16/2006] [Indexed: 11/21/2022]
Abstract
Pseudoaneurysm of the carotid artery is a rare complication of deep neck space infection. It carries a high mortality rate even when treated appropriately. We report a case of a pseudoaneurysm of the internal carotid artery in a 2-year-old child who had a neck infection without an associated abscess. The diagnosis was not obvious on MRI but was confirmed by ultrasonography. This was successfully managed by angiographic embolization, followed by antibiotic and anticoagulant treatment. The combination of MRI and ultrasonography, without the use of invasive or radiation techniques, was sufficient for the diagnosis of pseudoaneurysm of the internal carotid artery.
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Affiliation(s)
- Adi Biron
- Department of Otolaryngology, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Vic. 3052, Australia
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28
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Leibecke T, Kagel C, Lubienski A, Peters SO, Jungbluth T, Helmberger T. [CTA and MRA in peripheral arterial disease--is DSA out?]. Radiologe 2006; 46:941-7. [PMID: 17021910 DOI: 10.1007/s00117-006-1415-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
New developments in technique and postprocessing have led to further improvement in diagnosing and evaluating peripheral arterial disease (PAD) by noninvasive computed tomographic angiography (CTA) and magnetic resonance angiography (MRA). Under clinical conditions diagnostic conventional angiography (DSA) will be increasingly replaced by CTA and MRA. The radiologist has to become familiar with the field of indications, the different techniques, postprocessing tools, and effective visualization. In consideration of the current literature some methodological aspects and the role of CTA and MRA in PAD will be discussed.
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Affiliation(s)
- T Leibecke
- Klinik für diagnostische und interventionelle Radiologie, Klinikum Neustadt GmbH & Co KG, Schön Kliniken, Am Kiebitzberg 10, 23730 Neustadt/i. Holstein, Germany.
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29
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Beckman JA, Creager MA. Peripheral Arterial Disease: Clinical Evaluation. Vasc Med 2006. [DOI: 10.1016/b978-0-7216-0284-4.50023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Greiner A, Esterhammer R, Pilav S, Arnold W, Santner W, Neuhauser B, Fraedrich G, Jaschke WR, Schocke MFH. High-energy phosphate metabolism in the calf muscle during moderate isotonic exercise under different degrees of cuff compression: A phosphorus 31 magnetic resonance spectroscopy study. J Vasc Surg 2005; 42:259-67. [PMID: 16102624 DOI: 10.1016/j.jvs.2005.04.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Accepted: 04/24/2005] [Indexed: 12/01/2022]
Abstract
BACKGROUND The purpose of this study was to investigate phosphocreatine (PCr) and inorganic phosphate levels as well as pH changes in exercising muscle at a workload of 4.5 W under progressive cuff stenoses, whereby the flow reduction due to cuff compression was quantified by flow-sensitive magnetic resonance imaging. METHODS By using a whole-body 1.5-T magnetic resonance scanner and an exercise bench, serial phosphorus 31 (31P) magnetic resonance spectroscopy with a time resolution of 30 seconds was performed in 10 healthy men. Percentage changes in PCr, inorganic phosphate (Pi), and pH were statistically evaluated in comparison with baseline. The exercise protocol was characterized by a constant workload level of 4.5 W. Ischemic conditions were achieved by a cuff that was placed at the upper leg. Consecutively, increments of 0, 60, 90, 120, and 150 mm Hg were applied. Each increment lasted for 3 minutes. The following rest period was 10 minutes. RESULTS Blood flow increased significantly immediately after the onset of muscle exercise. No significant changes in blood flow were detected as long as the air pressure of the pneumatic cuff was 60 to 90 mm Hg. Significant reductions in blood flow were observed immediately after inflation of the cuff to 120 and 150 mm Hg. PCr passed into a steady state during the first increment with 0 mm Hg and showed no substantial changes during the increment with 60, 90, and 120 mm Hg. PCr hydrolysis seemed progressive during the 150-mm Hg increment. Pi passed into a plateau level at the onset of exercise and increased significantly at the increment of 150 mm Hg. The pH turned into a steady state with no significant changes during the increments up to 120 mm Hg. At 150 mm Hg, pH decreased progressively. PCr levels at the end of the 150-mm Hg increment correlated significantly and moderately with the reduction in blood flow. CONCLUSIONS Our study shows that the ischemic condition during constant muscle exercise is clearly characterized by PCr and Pi kinetics, as well as by pH changes. The correlation between the degree of blood flow reduction and PCr levels in the exercising muscle groups, which are supplied by the stenosed arteries, is the first essential of using 31P magnetic resonance spectroscopy in the assessment of the effect of arterial stenoses on muscle function in claudicants.
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Affiliation(s)
- Andreas Greiner
- Department of Surgery, Division of Vascular Surgery, Innsbruck Medical University, Austria.
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31
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Abstract
Vascular imaging techniques, such as catheter angiography, ultrasound, computed tomography (CT), and magnetic resonance (MR), have all undergone unprecedented innovation and incredible technological leaps in the last 10 years. Ultrasound, CT, and MR have progressed in acquisition speed, resolution, and accuracy to the point that they have now supplanted the former mainstay, invasive catheter-based angiography, despite the advent of digitized angiographic image recording. This review explores the advantages and shortcomings of each technique and how they have changed the diagnosis and assessment of the cardiovascular system for endovascular intervention.
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Affiliation(s)
- Allan W Reid
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
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Coffi SB, Ubbink DT, Legemate DA. Noninvasive Techniques to Detect Subcritical Iliac Artery Stenoses. Eur J Vasc Endovasc Surg 2005; 29:305-7. [PMID: 15694806 DOI: 10.1016/j.ejvs.2004.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2004] [Indexed: 11/30/2022]
Affiliation(s)
- S B Coffi
- Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands
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33
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Affiliation(s)
- James F Glockner
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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34
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Abstract
PURPOSE OF REVIEW The dilated aortic root is often completely asymptomatic and found incidentally on routine imaging studies such as chest radiograph, echocardiography, chest computed tomography, or magnetic resonance imaging. The dilated aortic root may be associated with underlying aortic valve abnormalities as seen with bicuspid aortic valve. It may also lead to the awareness of important underlying connective tissue disorders like the Marfan syndrome. It is imperative that the dilated aortic root be observed carefully over time with serial imaging studies and that timely resection of the aneurysm be carried out before catastrophic complications such as aortic dissection, aortic rupture, or congestive heart failure from aortic insufficiency occur. RECENT FINDINGS In recent years, the advent of molecular genetics has heightened awareness of familial aortic disease such as the Marfan syndrome, bicuspid aortic valve disease, and hereditary aortic aneurysm and dissection. In addition to hypertension and inflammatory aortic disease, these hereditary aortopathies are important to consider in the evaluation of patients with a dilated aorta and have implications for screening of the relatives of the patient with aortic aneurysm. SUMMARY Because there is often uncertainty regarding the dilated aortic root, this review will summarize the approach to diagnosis, evaluation, and management of aortic root aneurysms. Clinical features, diagnostic approaches, screening of relatives, and long term follow-up will be highlighted.
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Affiliation(s)
- John K Boyer
- Department of Medicine, and the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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35
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Abstract
The extensive worldwide disease burden attributable to tobacco smoking is reviewed, with particular attention to the epidemiologic and clinical aspects, molecular and cellular mechanisms, and pathophysiology of a variety of smoking-related pulmonary diseases, and the epidemiology and clinical presentation of smoking-related atherosclerotic disease as it affects the cardiovascular system cerebral circulation, the aorta, and the peripheral arterial tree.
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Affiliation(s)
- Stephan L Kamholz
- Department of Medicine, North Shore University Hospital and Long Island Jewish Medical Center, 300 Community Drive, Manhasset, NY 11030, USA.
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