1
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Diamond C, Pansini M, Hamid A, Eichert N, Pandya P, Ali SN, Kemp GJ, Thanabalasingham G, Thomaides Brears H, Cuthbertson DJ. Quantitative Imaging Reveals Steatosis and Fibroinflammation in Multiple Organs in People With Type 2 Diabetes: A Real-World Study. Diabetes 2024; 73:1285-1299. [PMID: 38748492 DOI: 10.2337/db23-0926] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/05/2024] [Indexed: 07/21/2024]
Abstract
We aimed to determine the extent of multiorgan fat accumulation and fibroinflammation in individuals living with type 2 diabetes. We deeply phenotyped individuals with type 2 diabetes (134 from secondary care, 69 from primary care) with multiorgan, quantitative, multiparametric MRI and compared with 134 matched control individuals without diabetes and 92 control individuals with normal weight. We examined the impact of diabetes duration, obesity status, and glycemic control. Ninety-three of the individuals with type 2 diabetes were reevaluated at 7 months (median). Multiorgan abnormalities were more common in individuals with type 2 diabetes (94%) than in age- and BMI-matched healthy individuals or healthy individuals with normal weight. We demonstrated a high burden of combined steatosis and fibroinflammation within the liver, pancreas, and kidneys (41%, 17%, and 10%) associated with visceral adiposity (73%) and poor vascular health (82%). Obesity was most closely associated with advanced liver disease, renal and visceral steatosis, and multiorgan abnormalities, while poor glycemic control was associated with pancreatic fibroinflammation. Pharmacological therapies with proven cardiorenal protection improved liver and vascular health unlike conventional glucose-lowering treatments, while weight loss or improved glycemic control reduced multiorgan adiposity (P ≤ 0.01). Quantitative imaging in people with type 2 diabetes highlights widespread organ abnormalities and may provide useful risk and treatment stratification. ARTICLE HIGHLIGHTS
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Affiliation(s)
| | - Michele Pansini
- Perspectum, Ltd., Oxford, U.K
- Clinica Di Radiologia EOC, Istituto Di Imaging Della Svizzera Italiana, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Azlinda Hamid
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, U.K
| | - Nicole Eichert
- Perspectum, Ltd., Oxford, U.K
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, U.K
| | | | - Sarah N Ali
- Royal Free London NHS Foundation Trust, London, U.K
| | - Graham J Kemp
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, U.K
| | - Gaya Thanabalasingham
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, U.K
| | | | - Daniel J Cuthbertson
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, U.K
- University Hospital Aintree, Liverpool University Hospitals NHS Foundation Trust, Liverpool, U.K
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2
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Yang X, Sullivan PF, Li B, Fan Z, Ding D, Shu J, Guo Y, Paschou P, Bao J, Shen L, Ritchie MD, Nave G, Platt ML, Li T, Zhu H, Zhao B. Multi-organ imaging-derived polygenic indexes for brain and body health. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.04.18.23288769. [PMID: 38883759 PMCID: PMC11177904 DOI: 10.1101/2023.04.18.23288769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
The UK Biobank (UKB) imaging project is a crucial resource for biomedical research, but is limited to 100,000 participants due to cost and accessibility barriers. Here we used genetic data to predict heritable imaging-derived phenotypes (IDPs) for a larger cohort. We developed and evaluated 4,375 IDP genetic scores (IGS) derived from UKB brain and body images. When applied to UKB participants who were not imaged, IGS revealed links to numerous phenotypes and stratified participants at increased risk for both brain and somatic diseases. For example, IGS identified individuals at higher risk for Alzheimer's disease and multiple sclerosis, offering additional insights beyond traditional polygenic risk scores of these diseases. When applied to independent external cohorts, IGS also stratified those at high disease risk in the All of Us Research Program and the Alzheimer's Disease Neuroimaging Initiative study. Our results demonstrate that, while the UKB imaging cohort is largely healthy and may not be the most enriched for disease risk management, it holds immense potential for stratifying the risk of various brain and body diseases in broader external genetic cohorts.
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Affiliation(s)
- Xiaochen Yang
- Department of Statistics, Purdue University, West Lafayette, IN 47907, USA
| | - Patrick F. Sullivan
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Bingxuan Li
- UCLA Samueli School of Engineering, Los Angeles, CA 90095, USA
| | - Zirui Fan
- Department of Statistics and Data Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dezheng Ding
- Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Juan Shu
- Department of Statistics, Purdue University, West Lafayette, IN 47907, USA
| | - Yuxin Guo
- Department of Biological Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - Peristera Paschou
- Department of Biological Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - Jingxuan Bao
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Graduate Group in Genomics and Computational Biology, University of Pennsylvania, Philadelphia, PA, USA
| | - Li Shen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Marylyn D. Ritchie
- Department of Genetics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Institute for Biomedical Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Gideon Nave
- Marketing Department, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michael L. Platt
- Marketing Department, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Tengfei Li
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Biomedical Research Imaging Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Hongtu Zhu
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Biomedical Research Imaging Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Bingxin Zhao
- Department of Statistics and Data Science, University of Pennsylvania, Philadelphia, PA 19104, USA
- Institute for Biomedical Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Applied Mathematics and Computational Science Graduate Group, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for AI and Data Science for Integrated Diagnostics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Population Aging Research Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
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3
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Applefeld WN, Jentzer JC. Initial Triage and Management of Patients with Acute Aortic Syndromes. Cardiol Clin 2024; 42:195-213. [PMID: 38631790 DOI: 10.1016/j.ccl.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The acute aortic syndromes (AAS) are life-threatening vascular compromises within the aortic wall. These include aortic dissection (AD), intramural hematoma (IMH), penetrating aortic ulcer (PAU), and blunt traumatic thoracic aortic injury (BTTAI). While patients classically present with chest pain, the presentation may be highly variable. Timely diagnosis is critical to initiate definitive treatment and maximize chances of survival. In high-risk patients, treatment should begin immediately, even while diagnostic evaluation proceeds. The mainstay of medical therapy is acute reduction of heart rate and blood pressure. Surgical intervention is often required but is informed by patient anatomy and extent of vascular compromise.
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Affiliation(s)
- Willard N Applefeld
- Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, 2301 Erwin Road, Durham, NC 27710, USA
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Balmforth C, Whittington B, Tzolos E, Bing R, Williams MC, Clark L, Corral CA, Tavares A, Dweck MR, Newby DE. Translational molecular imaging: Thrombosis imaging with positron emission tomography. J Nucl Cardiol 2024:101848. [PMID: 38499227 DOI: 10.1016/j.nuclcard.2024.101848] [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: 12/29/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 03/20/2024]
Abstract
A key focus of cardiovascular medicine is the detection, treatment, and prevention of disease, with a move towards more personalized and patient-centred treatments. To achieve this goal, novel imaging approaches that allow for early and accurate detection of disease and risk stratification are needed. At present, the diagnosis, monitoring, and prognostication of thrombotic cardiovascular diseases are based on imaging techniques that measure changes in structural anatomy and biological function. Molecular imaging is emerging as a new tool for the non-invasive detection of biological processes, such as thrombosis, that can improve identification of these events above and beyond current imaging modalities. At the forefront of these evolving techniques is the use of high-sensitivity radiotracers in conjunction with positron emission tomography imaging that could revolutionise current diagnostic paradigms by improving our understanding of the role and origin of thrombosis in a range of cardiovascular diseases.
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Affiliation(s)
- Craig Balmforth
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
| | - Beth Whittington
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Evangelos Tzolos
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Rong Bing
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Laura Clark
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Carlos Alcaide Corral
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Adriana Tavares
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Marc Richard Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - David Ernest Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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Ali AM, Ghobashy AA, Sultan AA, Elkhodary KI, El-Morsi M. A 3D scaling law for supravalvular aortic stenosis suited for stethoscopic auscultations. Heliyon 2024; 10:e26190. [PMID: 38390109 PMCID: PMC10881376 DOI: 10.1016/j.heliyon.2024.e26190] [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: 05/10/2023] [Revised: 11/24/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
In this study a frequency scaling law for 3D anatomically representative supravalvular aortic stenosis (SVAS) cases is proposed. The law is uncovered for stethoscopy's preferred auscultation range (70-120 Hz). LES simulations are performed on the CFD solver Fluent, leveraging Simulia's Living Heart Human Model (LHHM), modified to feature hourglass stenoses that range between 30 to 80 percent (mild to severe) in addition to the descending aorta. For physiological hemodynamic boundary conditions the Windkessel model is implemented via a UDF subroutine. The flow-generated acoustic signal is then extracted using the FW-H model and analyzed using FFT. A preferred receiver location that matches clinical practice is confirmed (right intercostal space) and a correlation between the degree of stenosis and a corresponding acoustic frequency is obtained. Five clinical auscultation signals are tested against the scaling law, with the findings interpreted in relation to the NHS classification of stenosis and to the assessments of experienced cardiologists. The scaling law is thus shown to succeed as a potential quantitative decision-support tool for clinicians, enabling them to reliably interpret stethoscopic auscultations for all degrees of stenosis, which is especially useful for moderate degrees of SVAS. Computational investigation of more complex stenotic cases would enhance the clinical relevance of this proposed scaling law, and will be explored in future research.
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Affiliation(s)
- Ahmed M Ali
- Department of Mechanical Engineering, The American University in Cairo, 11835 New Cairo, Egypt
| | - Aly A Ghobashy
- Department of Mechanical Engineering, The American University in Cairo, 11835 New Cairo, Egypt
| | - Abdelrahman A Sultan
- Department of Mechanical Engineering, The American University in Cairo, 11835 New Cairo, Egypt
| | - Khalil I Elkhodary
- Department of Mechanical Engineering, The American University in Cairo, 11835 New Cairo, Egypt
| | - Mohamed El-Morsi
- Department of Mechanical Engineering, The American University in Cairo, 11835 New Cairo, Egypt
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6
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Shah RD, Leviter J, Riera A. Acute and Critical Pathology Diagnosed by Timely Point-of-Care Ultrasound Review at a Tertiary Children's Hospital. Pediatr Emerg Care 2023; 39:636-640. [PMID: 37256276 DOI: 10.1097/pec.0000000000002974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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7
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Ali AM, Hafez AH, Elkhodary KI, El-Morsi M. A CFD-FFT approach to hemoacoustics that enables degree of stenosis prediction from stethoscopic signals. Heliyon 2023; 9:e17643. [PMID: 37449099 PMCID: PMC10336451 DOI: 10.1016/j.heliyon.2023.e17643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023] Open
Abstract
In this paper, we identify a new (acoustic) frequency-stenosis relation whose frequencies lie within the recommended auscultation threshold of stethoscopy (< 120 Hz). We show that this relation can be used to extend the application of phonoangiography (quantifying the degree of stenosis from bruits) to widely accessible stethoscopes. The relation is successfully identified from an analysis restricted to the acoustic signature of the von Karman vortex street, which we automatically single out by means of a metric we propose that is based on an area-weighted average of the Q-criterion for the post-stenotic region. Specifically, we perform CFD simulations on internal flow geometries that represent stenotic blood vessels of different severities. We then extract their emitted acoustic signals using the Ffowcs Williams-Hawkings equation, which we subtract from a clean signal (stenosis free) at the same heart rate. Next, we transform this differential signal to the frequency domain and carefully classify its acoustic signatures per six (stenosis-)invariant flow phases of a cardiac cycle that are newly identified in this paper. We then automatically restrict our acoustic analysis to the sounds emitted by the von Karman vortex street (phase 4) by means of our Q-criterion-based metric. Our analysis of its acoustic signature reveals a strong linear relationship between the degree of stenosis and its dominant frequency, which differs considerably from the break frequency and the heart rate (known dominant frequencies in the literature). Applying our new relation to available stethoscopic data, we find that its predictions are consistent with clinical assessment. Our finding of this linear correlation is also unlike prevalent scaling laws in the literature, which feature a small exponent (i.e., low stenosis percentage sensitivity over much of the clinical range). They hence can only distinguish mild, moderate, and severe cases. Conversely, our linear law can identify variations in the degree of stenosis sensitively and accurately for the full clinical range, thus significantly improving the utility of the relevant scaling laws... Future research will investigate incorporating the vibroacoustic role of adjacent organs to expand the clinical applicability of our findings. Extending our approach to more complex 3D stenotic morphologies and including the vibroacoustic role of surrounding organs will be explored in future research to advance the clinical reach of our findings.
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Affiliation(s)
- Ahmed M. Ali
- Department of Mechanical Engineering, The American University in Cairo, 11835 New Cairo, Egypt
| | - Ahmed H. Hafez
- Department of Mechanical Engineering, The American University in Cairo, 11835 New Cairo, Egypt
- Aerospace Engineering Department, Cairo University, 12511 Giza, Egypt
| | - Khalil I. Elkhodary
- Department of Mechanical Engineering, The American University in Cairo, 11835 New Cairo, Egypt
| | - Mohamed El-Morsi
- Department of Mechanical Engineering, The American University in Cairo, 11835 New Cairo, Egypt
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8
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Chen D, Schonberger AR, Ye K, Levsky JM. Coronary Calcium Predicts All-Cause Mortality in Suspected Acute Aortic Syndrome. Radiol Cardiothorac Imaging 2023; 5:e220188. [PMID: 37404788 PMCID: PMC10316301 DOI: 10.1148/ryct.220188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/28/2023] [Accepted: 04/28/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE To determine long-term clinical outcomes in patients with suspected acute aortic syndrome (AAS) and evaluate the prognostic value of coronary calcium burden as assessed with CT aortography in this symptomatic population. MATERIALS AND METHODS A retrospective cohort of all patients who underwent emergency CT aortography from January 2007 through January 2012 for suspected AAS was assembled. A medical record survey tool was used to evaluate subsequent clinical events over 10 years of follow-up. Events included death, aortic dissection, myocardial infarction, cerebrovascular accident, and pulmonary embolism. Coronary calcium scores were computed from original images using a validated simple 12-point ordinal method and categorized into none, low (1-3), moderate (4-6), or high (7-12) groupings. Survival analysis with Kaplan-Meier curves and Cox proportional hazard modeling was performed. RESULTS The study cohort comprised 1658 patients (mean age, 60 years ± 16 [SD]; 944 women), with 595 (35.9%) developing a clinical event over a median follow-up of 6.9 years. Patients with high coronary calcium demonstrated the highest mortality rate (adjusted hazard ratio = 2.36; 95% CI: 1.65, 3.37). Patients with low coronary calcium demonstrated lower mortality, but rates were still almost twice as high compared with patients with no detectable calcium (adjusted hazard ratio = 1.89; 95% CI: 1.41, 2.53). Coronary calcium was a strong predictor of major adverse cardiovascular events (P < .001), which persisted after adjustment for common significant comorbidities. CONCLUSION Patients with suspected AAS had a high rate of subsequent clinical events, including death. CT aortography-based coronary calcium scores strongly and independently predicted all-cause mortality.Keywords: Acute Aortic Syndrome, Coronary Artery Calcium, CT Aortography, Major Adverse Cardiovascular Events, Mortality Supplemental material is available for this article. © RSNA, 2023See also commentary by Weir-McCall and Shambrook in this issue.
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9
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Parenti VG, Vijay K, Maroules CD, Majdalany BS, Koweek LM, Khaja MS, Ghoshhajra BB, Agarwal PP, Contrella BN, Keefe NA, Lo BM, Malik SB, Surasi DS, Waite K, Williamson EE, Abbara S, Dill KE. ACR Appropriateness Criteria® Workup of Noncerebral Systemic Arterial Embolic Source. J Am Coll Radiol 2023; 20:S285-S300. [PMID: 37236749 DOI: 10.1016/j.jacr.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Noncerebral systemic arterial embolism, which can originate from cardiac and noncardiac sources, is an important cause of patient morbidity and mortality. When an embolic source dislodges, the resulting embolus can occlude a variety of peripheral and visceral arteries causing ischemia. Characteristic locations for noncerebral arterial occlusion include the upper extremities, abdominal viscera, and lower extremities. Ischemia in these regions can progress to tissue infarction resulting in limb amputation, bowel resection, or nephrectomy. Determining the source of arterial embolism is essential in order to direct treatment decisions. This document reviews the appropriateness category of various imaging procedures available to determine the source of the arterial embolism. The variants included in this document are known arterial occlusion in the upper extremity, lower extremity, mesentery, kidneys, and multiorgan distribution that are suspected to be of embolic etiology. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Vincent G Parenti
- Research Author, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | | | - Lynne M Koweek
- Panel Chair, Duke University Medical Center, Durham, North Carolina
| | | | | | | | | | - Nicole A Keefe
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Bruce M Lo
- Sentara Norfolk General Hospital/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - Sachin B Malik
- VA Palo Alto Health Care System, Palo Alto, California and Stanford University, Stanford, California
| | - Devaki Shilpa Surasi
- The University of Texas MD Anderson Cancer Center, Houston, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Kathleen Waite
- Duke University Medical Center, Durham, North Carolina, Primary care physician
| | - Eric E Williamson
- Mayo Clinic, Rochester, Minnesota; Society of Cardiovascular Computed Tomography
| | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
| | - Karin E Dill
- Specialty Chair, Emory University Hospital, Atlanta, Georgia
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10
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Moghiseh M, Searle E, Dixit D, Kim J, Dong YC, Cormode DP, Butler A, Gieseg SP. Spectral Photon-Counting CT Imaging of Gold Nanoparticle Labelled Monocytes for Detection of Atherosclerosis: A Preclinical Study. Diagnostics (Basel) 2023; 13:diagnostics13030499. [PMID: 36766602 PMCID: PMC9914700 DOI: 10.3390/diagnostics13030499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
A key process in the development of atherosclerotic plaques is the recruitment of monocytes into the artery wall. Using spectral photon-counting computed tomography we examine whether monocyte deposition within the artery wall of ApoE-/- mouse can be detected. Primary mouse monocytes were labelled by incubating them with 15 nm gold nanoparticles coated with 11-mercaptoundecanoic acid The monocyte uptake of the particle was confirmed by electron microscopy of the cells before injection into 6-week-old apolipoprotein E deficient (ApoE-/-) mouse that had been fed with the Western diet for 10 weeks. Four days following injection, the mouse was sacrificed and imaged using a MARS spectral photon counting computed tomography scanner with a spectral range of 7 to 120 KeV with five energy bins. Imaging analysis showed the presence of X-ray dense material within the mouse aortic arch which was consistent with the spectral characteristic of gold rather than calcium. The imaging is interpreted as showing the deposition of gold nanoparticles containing monocytes within the mouse aorta. The results of our study determined that spectral photon-counting computed tomography could provide quantitative information about gold nanoparticles labelled monocytes in voxels of 90 × 90 × 90 µm3. The imaging was consistent with previous micro-CT and electron microscopy of mice using the same nanoparticles. This study demonstrates that spectral photon-counting computed tomography, using a MARS small bore scanner, can detect a fundamental atherogenic process within mouse models of atherogenesis. The present study demonstrates the feasibility of spectral photon-counting computed tomography as an emerging molecular imaging modality to detect atherosclerotic disease.
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Affiliation(s)
- Mahdieh Moghiseh
- Department of Radiology, University of Otago, Christchurch 9016, New Zealand
- MARS Bioimaging Ltd., Christchurch 8041, New Zealand
- Correspondence: (M.M.); (S.P.G.)
| | - Emily Searle
- MARS Bioimaging Ltd., Christchurch 8041, New Zealand
- Free Radical Biochemistry Laboratory, School of Biological Sciences, University of Canterbury, Christchurch 8041, New Zealand
- Department of Physics and Astronomy, University of Canterbury, Christchurch 8041, New Zealand
| | - Devyani Dixit
- MARS Bioimaging Ltd., Christchurch 8041, New Zealand
- Free Radical Biochemistry Laboratory, School of Biological Sciences, University of Canterbury, Christchurch 8041, New Zealand
| | - Johoon Kim
- Departments of Radiology, Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yuxi C. Dong
- Departments of Radiology, Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David P. Cormode
- Departments of Radiology, Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Anthony Butler
- Department of Radiology, University of Otago, Christchurch 9016, New Zealand
- MARS Bioimaging Ltd., Christchurch 8041, New Zealand
- Department of Physics and Astronomy, University of Canterbury, Christchurch 8041, New Zealand
- European Organization for Nuclear Research (CERN), 1211 Meyrin, Switzerland
| | - Steven P. Gieseg
- Department of Radiology, University of Otago, Christchurch 9016, New Zealand
- MARS Bioimaging Ltd., Christchurch 8041, New Zealand
- Free Radical Biochemistry Laboratory, School of Biological Sciences, University of Canterbury, Christchurch 8041, New Zealand
- European Organization for Nuclear Research (CERN), 1211 Meyrin, Switzerland
- Correspondence: (M.M.); (S.P.G.)
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11
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Shmukler A, Alis J, Patel S, Latson L, Ko JP. Pitfalls and Pearls of Imaging Non-traumatic Thoracic Aortic Disease. Semin Ultrasound CT MR 2022; 43:204-220. [PMID: 35688532 DOI: 10.1053/j.sult.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Imaging of the thoracic aorta is a common request in both the acute and outpatient settings, playing a crucial role in diagnosis and treatment planning of aortic disease. The findings of aortic pathology may be obvious or occult on imaging. Recognizing subtle changes is essential and may lead to early detection and prevention of serious morbidity and mortality. Knowledge of the anatomy and understanding the pathophysiology of aortic disease, as well as selecting the appropriate imaging modality and protocol will enable prompt diagnosis and early intervention of aortic pathology. Currently, computed tomography angiography and magnetic resonance angiography of the aorta are the most commonly used imaging modalities to evaluate the aorta. This review focuses on a spectrum of aortic pathology manifestations on computed tomography and magnetic resonance, including atherosclerosis and acute aortic syndromes, highlighting diagnostic challenges and approaches to aid in image interpretation.
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Affiliation(s)
- Anna Shmukler
- Department of Radiology, NYU Langone Health, New York, NY.
| | - Jonathan Alis
- Department of Radiology, Jacobi Medical Center, Bronx, NY
| | - Smita Patel
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI
| | - Larry Latson
- Department of Radiology, NewYork-Presbyterian / Weill Cornell Medicine, New York, NY
| | - Jane P Ko
- Department of Radiology, NYU Langone Health, New York, NY
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12
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MDCT Imaging of Non-Traumatic Thoracic Aortic Emergencies and Its Impact on Diagnosis and Management—A Reappraisal. Tomography 2022; 8:200-228. [PMID: 35076599 PMCID: PMC8788571 DOI: 10.3390/tomography8010017] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 01/16/2023] Open
Abstract
Non-traumatic thoracic aorta emergencies are associated with significant morbidity and mortality. Diseases of the intimomedial layers (aortic dissection and variants) have been grouped under the common term of acute aortic syndrome because they are life-threatening conditions clinically indistinguishable on presentation. Patients with aortic dissection may present with a wide variety of symptoms secondary to the pattern of dissection and end organ malperfusion. Other conditions may be seen in patients with acute symptoms, including ruptured and unstable thoracic aortic aneurysm, iatrogenic or infective pseudoaneurysms, aortic fistula, acute aortic thrombus/occlusive disease, and vasculitis. Imaging plays a pivotal role in the patient’s management and care. In the emergency room, chest X-ray is the initial imaging test offering a screening evaluation for alternative common differential diagnoses and a preliminary assessment of the mediastinal dimensions. State-of-the-art multidetector computed tomography angiography (CTA) provides a widely available, rapid, replicable, noninvasive diagnostic imaging with sensitivity approaching 100%. It is an impressive tool in decision-making process with a deep impact on treatment including endovascular or open surgical or conservative treatment. Radiologists must be familiar with the spectrum of these entities to help triage patients appropriately and efficiently. Understanding the imaging findings and proper measurement techniques allow the radiologist to suggest the most appropriate next management step.
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Ueda T, Hayashi H, Ando T, Iwata K, Saito H, Kumita SI. Computed Tomography Attenuation Values of the High-Attenuating Crescent Sign Can Discriminate Between Rupture, Impending Rupture, and Non-Rupture of Aortic Aneurysms. Circ J 2021; 85:2184-2190. [PMID: 34707030 DOI: 10.1253/circj.cj-21-0541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although the high-attenuating crescent (HAC) sign can indicate aortic aneurysm (AA) impending rupture, the relation of its computed tomography (CT) value to the aneurysmal status remains unclear. This study compared the HAC sign CT-attenuation values among rupture, impending rupture, and non-rupture AA cases.Methods and Results:This included 76 patients (mean age: 77.0 years) diagnosed with HAC sign-associated AA between January 2005 and July 2015. The CT-attenuation values of the HAC sign (H) and aortic lumen (A) using region-of-interest methodology were measured and the H/A ratio was calculated. The study classified patients into the rupture group (R-G, n=36), impending rupture group (IR-G, n=16), and non-rupture group (NR-G, n=24); the H and the H/A ratio were compared among them. Additionally, the H and the H/A ratio cut-offs between the IR-G and NR-G groups were evaluated. The H and the H/A ratio were significantly higher in the R-G and IR-G than in the NR-G (both P<0.001); the H/A ratio was significantly higher in the R-G than in the IR-G (P=0.038). The optimal cut-off for H between the IR-G and NR-G was 50.3 Hounsfield units (area under the curve [AUC]=0.875; sensitivity=87.5%; specificity=87.5%), and that for the H/A ratio was 1.3 (AUC=0.909; sensitivity=91.7%; specificity=87.5%). CONCLUSIONS Among patients with AA, the H and the H/A ratio were significantly higher in cases of rupture and impending rupture than in those of non-rupture.
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Affiliation(s)
- Tatsuo Ueda
- Department of Radiology, Nippon Medical School Hospital
| | | | - Takahiro Ando
- Department of Radiology, Nippon Medical School Hospital
| | - Kotomi Iwata
- Department of Radiology, Nippon Medical School Hospital
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El-Abd YJ, Hagspiel KD. Review of Imaging With Focus on New Techniques in Aortic Dissection. Tech Vasc Interv Radiol 2021; 24:100748. [PMID: 34602264 DOI: 10.1016/j.tvir.2021.100748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The imaging evaluation of a patient with aortic dissection can be undoubtedly complex, requiring that the interpreting physician understands the classification systems and vocabulary used. This can be made all the more challenging by advances in medical imaging that reshape the understanding of aortic dissection. The purpose of this paper is to provide a review of recent advances in the imaging modalities, and select modality-specific technologies, commonly used to study aortic dissection, including computed tomography, magnetic resonance imaging, and ultrasound. This is followed by an overview of imaging findings, including the classification, initial evaluation, and follow up, of aortic dissection.
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Affiliation(s)
- Yasser J El-Abd
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
| | - Klaus D Hagspiel
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA.
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Michev A, Lungarotti L, Prevedoni Gorone MS, Apicella A, Di Vincenzo G, Marseglia GL, Brambilla I. Scoliosis with peculiar radiological features in a patient with McCune-Albright syndrome. Clin Case Rep 2021; 9:e04242. [PMID: 34322238 PMCID: PMC8301555 DOI: 10.1002/ccr3.4242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/23/2021] [Accepted: 04/14/2021] [Indexed: 11/11/2022] Open
Abstract
Patients with McCune-Albright Syndrome (MAS) should always attend regular follow-up. Beside the endocrinological aspects, the screening must take into account osteoarticular complications such as scoliosis, even in patients without fibrous dysplasia.
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Affiliation(s)
- Alexandre Michev
- Pediatric ClinicIRCCS Policlinico San Matteo FoundationUniversity of PaviaPaviaItaly
| | - Luca Lungarotti
- Department of Diagnostic Medicine and Services, Radiology/Radiodiagnostic ServiceIRCCS Policlinico San Matteo FoundationPaviaItaly
| | - Maria Sole Prevedoni Gorone
- Department of Diagnostic Medicine and Services, Radiology/Radiodiagnostic ServiceIRCCS Policlinico San Matteo FoundationPaviaItaly
| | - Antonia Apicella
- Pediatric ClinicIRCCS Policlinico San Matteo FoundationUniversity of PaviaPaviaItaly
| | - Giulia Di Vincenzo
- Pediatric ClinicIRCCS Policlinico San Matteo FoundationUniversity of PaviaPaviaItaly
| | - Gian Luigi Marseglia
- Pediatric ClinicIRCCS Policlinico San Matteo FoundationUniversity of PaviaPaviaItaly
- Pediatric ClinicIRCCS Policlinico San Matteo FoundationPaviaItaly
| | - Ilaria Brambilla
- Pediatric ClinicIRCCS Policlinico San Matteo FoundationPaviaItaly
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Wan Ab Naim WN, Sun Z, Liew YM, Chan BT, Jansen S, Lei J, Ganesan PB, Hashim SA, Sridhar GS, Lim E. Comparison of diametric and volumetric changes in Stanford type B aortic dissection patients in assessing aortic remodeling post-stent graft treatment. Quant Imaging Med Surg 2021; 11:1723-1736. [PMID: 33936960 DOI: 10.21037/qims-20-814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The study aims to analyze the correlation between the maximal diameter (both axial and orthogonal) and volume changes in the true (TL) and false lumens (FL) after stent-grafting for Stanford type B aortic dissection. Method Computed tomography angiography was performed on 13 type B aortic dissection patients before and after procedure, and at 6 and 12 months follow-up. The lumens were divided into three regions: the stented area (Region 1), distal to the stent graft to the celiac artery (Region 2), and between the celiac artery and the iliac bifurcation (Region 3). Changes in aortic morphology were quantified by the increase or decrease of diametric and volumetric percentages from baseline measurements. Results At Region 1, the TL diameter and volume increased (pre-treatment: volume =51.4±41.9 mL, maximal axial diameter =22.4±6.8 mm, maximal orthogonal diameter =21.6±7.2 mm; follow-up: volume =130.7±69.2 mL, maximal axial diameter =40.1±8.1 mm, maximal orthogonal diameter =31.9+2.6 mm, P<0.05 for all comparisons), while FL decreased (pre-treatment: volume =129.6±150.5 mL; maximal axial diameter =43.0±15.8 mm; maximal orthogonal diameter =28.3±12.6 mm; follow-up: volume =66.6±95.0 mL, maximal axial diameter =24.5±19.9 mm, maximal orthogonal diameter =16.9±13.7, P<0.05 for all comparisons). Due to the uniformity in size throughout the vessel, high concordance was observed between diametric and volumetric measurements in the stented region with 93% and 92% between maximal axial diameter and volume for the true/false lumens, and 90% and 92% between maximal orthogonal diameter and volume for the true/false lumens. Large discrepancies were observed between the different measurement methods at regions distal to the stent graft, with up to 46% differences between maximal orthogonal diameter and volume. Conclusions Volume measurement was shown to be a much more sensitive indicator in identifying lumen expansion/shrinkage at the distal stented region.
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Affiliation(s)
- Wan Naimah Wan Ab Naim
- Faculty of Mechanical and Automotive Engineering Technology, University Malaysia Pahang, 26600, Pekan, Pahang, Malaysia
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin University, Perth 6845, Australia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Bee Ting Chan
- Department of Mechanical, Materials and Manufacturing, Faculty of Science and Engineering, University of Nottingham Malaysia, 43500 Semenyih, Selangor, Malaysia
| | - Shirley Jansen
- Department of Vascular Surgery, Sir Charles Gairdner Hospital, Nedlands, Perth WA 6009, Australia.,Curtin Medical School, Curtin University, Perth 6845, Australia.,University of Western Australia, Crawley WA 6009, Australia
| | - Jing Lei
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Poo Balan Ganesan
- Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Shahrul Amry Hashim
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | | | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Gunn AJ, Kalva SP, Majdalany BS, Craft J, Eldrup-Jorgensen J, Ferencik M, Ganguli S, Kendi AT, Khaja MS, Obara P, Russell RR, Sutphin PD, Vijay K, Wang DS, Dill KE. ACR Appropriateness Criteria® Nontraumatic Aortic Disease. J Am Coll Radiol 2021; 18:S106-S118. [PMID: 33958105 DOI: 10.1016/j.jacr.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 01/16/2023]
Abstract
Nontraumatic aortic disease can be caused by a wide variety of disorders including congenital, inflammatory, infectious, metabolic, neoplastic, and degenerative processes. Imaging examinations such as radiography, ultrasound, echocardiography, catheter-based angiography, CT, MRI, and nuclear medicine examinations are essential for diagnosis, treatment planning, and assessment of therapeutic response. Depending upon the clinical scenario, each of these modalities has strengths and weaknesses. Whenever possible, the selection of a diagnostic imaging examination should be based upon the best available evidence. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. The purpose of this document is to assist physicians select the most appropriate diagnostic imaging examination for nontraumatic aortic diseases.
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Affiliation(s)
- Andrew J Gunn
- University of Alabama at Birmingham, Birmingham, Alabama, Director, Interventional Oncology, Director, Ambulatory Clinic, Assistant Program Director, Diagnostic Radiology Residency, Assistant Program Director, Interventional Radiology Residency, University of Alabama at Birmingham, Member, American College of Radiology-Radiologic Society of North America Patient Information Committee.
| | - Sanjeeva P Kalva
- Panel Chair, Massachusetts General Hospital, Boston, Massachusetts, Chief, Division of Interventional Radiology, Massachusetts General Hospital
| | | | - Jason Craft
- St. Francis Hospital, Catholic Health Services of Long Island, Roslyn, New York, Society for Cardiovascular Magnetic Resonance
| | - Jens Eldrup-Jorgensen
- Tufts University School of Medicine, Boston, Massachusetts, Society for Vascular Surgery
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, Society of Cardiovascular Computed Tomography
| | | | - A Tuba Kendi
- Mayo Clinic, Rochester, Minnesota, Director of Nuclear Medicine Therapies at Mayo Clinic Rochester
| | - Minhajuddin S Khaja
- University of Virginia, Charlottesville, Virginia, Vice-Chair ACR Vascular Imaging Panel 2, Program Director, Independent IR Residency, UVA Health
| | - Piotr Obara
- Loyola University Medical Center, Maywood, Illinois
| | - Raymond R Russell
- The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, Nuclear cardiology expert, Program Director, Cardiology Fellowship, Director, Nuclear Cardiology, Director, Cardio-Oncology Program, Rhode Island Hospital
| | | | | | - David S Wang
- Stanford University Medical Center, Stanford, California
| | - Karin E Dill
- Specialty Chair, Emory University Hospital, Atlanta, Georgia
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Mirmomen SM, Arai AE, Turkbey EB, Bradley AJ, Sapp JC, Biesecker LG, Sirajuddin A. Cardiothoracic imaging findings of Proteus syndrome. Sci Rep 2021; 11:6577. [PMID: 33753828 PMCID: PMC7985501 DOI: 10.1038/s41598-021-86029-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/08/2021] [Indexed: 12/12/2022] Open
Abstract
In this work, we sought to delineate the prevalence of cardiothoracic imaging findings of Proteus syndrome in a large cohort at our institution. Of 53 individuals with a confirmed diagnosis of Proteus syndrome at our institution from 10/2001 to 10/2019, 38 individuals (men, n = 23; average age = 24 years) underwent cardiothoracic imaging (routine chest CT, CT pulmonary angiography and/or cardiac MRI). All studies were retrospectively and independently reviewed by two fellowship-trained cardiothoracic readers. Disagreements were resolved by consensus. Differences between variables were analyzed via parametric and nonparametric tests based on the normality of the distribution. The cardiothoracic findings of Proteus syndrome were diverse, but several were much more common and included: scoliosis from bony overgrowth (94%), pulmonary venous dilation (62%), band-like areas of lung scarring (56%), and hyperlucent lung parenchyma (50%). In addition, of 20 individuals who underwent cardiac MRI, 9/20 (45%) had intramyocardial fat, mostly involving the endocardial surface of the left ventricular septal wall. There was no statistically significant difference among the functional cardiac parameters between individuals with and without intramyocardial fat. Only one individual with intramyocardial fat had mildly decreased function (LVEF = 53%), while all others had normal ejection fraction.
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Affiliation(s)
- S Mojdeh Mirmomen
- Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room B1D416, 10 Center Drive, Bethesda, MD, 20814, USA
| | - Andrew E Arai
- Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room B1D416, 10 Center Drive, Bethesda, MD, 20814, USA
| | - Evrim B Turkbey
- Radiology and Imaging Sciences, National Institutes of Health, Building 10, Room 1C336, Bethesda, MD, 20814, USA
| | - Andrew J Bradley
- Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room B1D416, 10 Center Drive, Bethesda, MD, 20814, USA
| | - Julie C Sapp
- Genetic Disease Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 10, Room 8D47E, Bethesda, MD, 20814, USA
| | - Leslie G Biesecker
- Genetic Disease Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 10, Room 8D47E, Bethesda, MD, 20814, USA
| | - Arlene Sirajuddin
- Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room B1D416, 10 Center Drive, Bethesda, MD, 20814, USA.
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Dev R, Gitanjali K, Anshuman D. Demystifying penetrating atherosclerotic ulcer of aorta: unrealised tyrant of senile aortic changes. J Cardiovasc Thorac Res 2021; 13:1-14. [PMID: 33815696 PMCID: PMC8007901 DOI: 10.34172/jcvtr.2021.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/09/2021] [Indexed: 12/14/2022] Open
Abstract
This review article describes demographic features, comorbidities, clinical and imaging findings, prognosis, and treatment strategies in penetrating atherosclerotic ulcer (PAU) and closely related entities using google scholar web search. PAU is one of the manifestations of the acute aortic syndrome (AAS) spectrum. The underlying aorta invariably shows atherosclerotic changes or aneurysmal dilatation. Hypertension is the most common contributing factor, with chest or back pain being the usual manifestation. Intramural hematoma (IMH) is the second entity associated with both PAU and aortic dissection (AD), more so with the latter. Chest radiograph can show mediastinal widening, pleural, or pericardial fluid in rupture. Computed tomography angiography (CTA) is the imaging modality of choice to visualize PAU, with magnetic resonance imaging (MRI) and transoesophageal echocardiography (TEE) adding diagnostic value. Lesser-known entities of intramural blood pool (IBP), limited intimal tears (LITs), and focal intimal disruptions (FID) are also encountered. PAU can form fistulous communication with adjacent organs whereas IMH may propagate to dissection. CTA aids in defining the management, open or endovascular options in surgical candidates.
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Affiliation(s)
- Rahul Dev
- Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Rishikesh, Uttarakhand-249203, India
| | - Khorwal Gitanjali
- Department of Anatomy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand-249203, India
| | - Darbari Anshuman
- Department of Cardiothoracic and Vascular Surgery (CTVS), All India Institute of Medical Sciences, Rishikesh, Uttarakhand-249203, India
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Steady State Magnetic Resonance Angiography of the Thoracic Aorta Using Inversion-recovery Steady-State Free Precession and a High Relaxivity Contrast Agent. J Thorac Imaging 2020; 35:377-382. [PMID: 32079906 DOI: 10.1097/rti.0000000000000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate image quality and aortic dimension measurement accuracy of high resolution, motion compensated steady-state magnetic resonance angiography (SS-MRA) with a high relaxivity, extracellular fluid gadolinium-based contrast agent compared with standard first-pass contrast enhanced MRA (FP-CEMRA) in patients with thoracic aortic aneurysms. MATERIALS AND METHODS Sixty-nine patients (mean age, 51.7 y, 25% female) diagnosed with thoracic aortic aneurysms who underwent MRA on a 1.5 T scanner using FP-CEMRA and SS-MRA techniques were retrospectively identified. Quantitative analysis was performed by measuring the aortic diameters at 6 locations within the thoracic aorta for each technique. Two radiologists independently performed the qualitative analysis by assessing the image quality (1 to 5), presence of artifact (1 to 4), signal-to-noise (1 to 4), contrast-to-noise (1 to 4), and wall conspicuity (1 to 4) in the aorta at 4 different locations: the aortic root, the ascending aorta, the aortic arch, and the descending aorta. RESULTS The aortic dimensions obtained by SS-MRA had a good correlation with FP-CEMRA. Means for the aortic diameters between the FP-CEMRA and the SS-MRA at all 6 locations demonstrated minimal mean differences (0.013 to 0.044 mm).Qualitative assessment of aorta at 4 locations by 2 reviewers demonstrated that SS-MRA had on average superior image quality at the aortic root and ascending aorta for both reviewers (P<0.05) and at the descending aorta for one reader (P<0.05). Otherwise, both techniques were comparable at the ascending aorta. SS-MRA demonstrated less artifact at the aortic root and the ascending aorta (P<0.05). CONCLUSION Aortic dimension measurements provided by SS-MRA with a high relaxivity, extracellular fluid gadolinium-based contrast agent are comparable to the conventional FP-CEMRA. Furthermore, SS-MRA qualitatively demonstrated comparable to better overall image quality than FP-CEMRA at different aortic locations. Therefore, SS-MRA may provide a comparable alternative, or complementary examination to conventional FP-CEMRA in patients who have difficulty breath holding, or in situations where contrast bolus timing was poor.
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Chakshu NK, Sazonov I, Nithiarasu P. Towards enabling a cardiovascular digital twin for human systemic circulation using inverse analysis. Biomech Model Mechanobiol 2020; 20:449-465. [PMID: 33064221 PMCID: PMC7979679 DOI: 10.1007/s10237-020-01393-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 09/29/2020] [Indexed: 12/11/2022]
Abstract
An exponential rise in patient data provides an excellent opportunity to improve the existing health care infrastructure. In the present work, a method to enable cardiovascular digital twin is proposed using inverse analysis. Conventionally, accurate analytical solutions for inverse analysis in linear problems have been proposed and used. However, these methods fail or are not efficient for nonlinear systems, such as blood flow in the cardiovascular system (systemic circulation) that involves high degree of nonlinearity. To address this, a methodology for inverse analysis using recurrent neural network for the cardiovascular system is proposed in this work, using a virtual patient database. Blood pressure waveforms in various vessels of the body are inversely calculated with the help of long short-term memory (LSTM) cells by inputting pressure waveforms from three non-invasively accessible blood vessels (carotid, femoral and brachial arteries). The inverse analysis system built this way is applied to the detection of abdominal aortic aneurysm (AAA) and its severity using neural networks.
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Affiliation(s)
- Neeraj Kavan Chakshu
- Biomedical Engineering Group, Zienkiewicz Centre for Computational Engineering, College of Engineering, Swansea University, Swansea, SA2 8PP, UK
| | - Igor Sazonov
- Biomedical Engineering Group, Zienkiewicz Centre for Computational Engineering, College of Engineering, Swansea University, Swansea, SA2 8PP, UK
| | - Perumal Nithiarasu
- Biomedical Engineering Group, Zienkiewicz Centre for Computational Engineering, College of Engineering, Swansea University, Swansea, SA2 8PP, UK.
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Mansour J, Zulfiqar M, Umer A, Zurcher KS, Heeger A, Menias CO. Abdominal Imaging Manifestations of Recreational Drug Use. Radiographics 2020; 40:1895-1915. [PMID: 33064622 DOI: 10.1148/rg.2020200048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Recreational drug use is a burgeoning health issue worldwide, with a variety of presenting symptoms and complications. These complications can be secondary to the toxic effects of the drug itself, drug impurities, and nonsterile injection. The abdominal radiologist is likely to encounter patients who use drugs recreationally and may be responsible for recognizing and reporting these acute conditions, which in some cases can be life threatening. Because these patients often present with an altered mental state and may deny or withhold information on drug use, the underlying cause may be difficult to determine. The most commonly used drugs worldwide include cocaine, cannabinoids, opioids, and amphetamines and their derivatives. Complications of use of these drugs that can be seen at abdominopelvic CT can involve multiple organ systems, including the soft tissue and gastrointestinal, genitourinary, vascular, and musculoskeletal systems. A diverse range of abdominal complications associated with these drugs can be seen at imaging, including disseminated infections, gastrointestinal ischemia, and visceral infarction. Radiologists should be familiar with the imaging findings of these complications to accurately diagnose these entities and help guide workup and patient treatment. ©RSNA, 2020.
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Affiliation(s)
- Joseph Mansour
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
| | - Maria Zulfiqar
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
| | - Affan Umer
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
| | - Kenneth S Zurcher
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
| | - Allen Heeger
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
| | - Christine O Menias
- From the Department of Radiology, Saint Louis University Hospital, 3635 Vista Ave, 2nd Floor, Deslodge Tower, St Louis, MO 63103-2097 (J.M., A.U.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (J.M., M.Z.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S.Z., C.O.M.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.H.)
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Richter GM. State-of-the-Art Imaging of the Aorta with Respect to Endoluminal Intervention. Cardiovasc Intervent Radiol 2020; 43:1745-1755. [DOI: 10.1007/s00270-020-02680-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/05/2020] [Indexed: 01/16/2023]
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24
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Multimodality Imaging of Aortic Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00831-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Andrews JPM, Portal C, Walton T, Macaskill MG, Hadoke PWF, Alcaide Corral C, Lucatelli C, Wilson S, Wilson I, MacNaught G, Dweck MR, Newby DE, Tavares AAS. Non-invasive in vivo imaging of acute thrombosis: development of a novel factor XIIIa radiotracer. Eur Heart J Cardiovasc Imaging 2020; 21:673-682. [PMID: 31408105 PMCID: PMC7237957 DOI: 10.1093/ehjci/jez207] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/01/2019] [Accepted: 08/07/2019] [Indexed: 11/12/2022] Open
Abstract
AIMS Cardiovascular thrombosis is responsible a quarter of deaths annually worldwide. Current imaging methods for cardiovascular thrombosis focus on anatomical identification of thrombus but cannot determine thrombus age or activity. Molecular imaging techniques hold promise for identification and quantification of thrombosis in vivo. Our objective was to assess a novel optical and positron-emitting probe targeting Factor XIIIa (ENC2015) as biomarker of active thrombus formation. METHODS AND RESULTS Optical and positron-emitting ENC2015 probes were assessed ex vivo using blood drawn from human volunteers and passed through perfusion chambers containing denuded porcine aorta as a model of arterial injury. Specificity of ENC2015 was established with co-infusion of a factor XIIIa inhibitor. In vivo18F-ENC2015 biodistribution, kinetics, radiometabolism, and thrombus binding were characterized in rats. Both Cy5 and fluorine-18 labelled ENC2015 rapidly and specifically bound to thrombi. Thrombus uptake was inhibited by a factor XIIIa inhibitor. 18F-ENC2015 remained unmetabolized over 8 h when incubated in ex vivo human blood. In vivo, 42% of parent radiotracer remained in blood 60 min post-administration. Biodistribution studies demonstrated rapid clearance from tissues with elimination via the urinary system. In vivo,18F-ENC2015 uptake was markedly increased in the thrombosed carotid artery compared to the contralateral patent artery (mean standard uptake value ratio of 2.40 vs. 0.74, P < 0.0001). CONCLUSION ENC2015 rapidly and selectively binds to acute thrombus in both an ex vivo human translational model and an in vivo rodent model of arterial thrombosis. This probe holds promise for the non-invasive identification of thrombus formation in cardiovascular disease.
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Affiliation(s)
- Jack P M Andrews
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, UK, Corresponding author. Tel: +44 (77) 6688 5010; Fax: +131 242 6379. E-mail:
| | - Christophe Portal
- Edinburgh Molecular Imaging Ltd., 9 Little France Road, Edinburgh, UK
| | - Tashfeen Walton
- Edinburgh Imaging facility QMRI, University of Edinburgh, 47 Little France Crescent, Edinburgh, UK
| | - Mark G Macaskill
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, UK
| | - Patrick W F Hadoke
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, UK
| | - Carlos Alcaide Corral
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, UK
| | - Christophe Lucatelli
- Edinburgh Imaging facility QMRI, University of Edinburgh, 47 Little France Crescent, Edinburgh, UK
| | - Simon Wilson
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, UK
| | - Ian Wilson
- ImaginAb, Inc. U.S. 43 Hindry Avenue, Suite D, Inglewood, California, USA
| | - Gillian MacNaught
- Edinburgh Imaging facility QMRI, University of Edinburgh, 47 Little France Crescent, Edinburgh, UK
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, UK
| | - Adriana A S Tavares
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, UK
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Xu B, Kocyigit D, Betancor J, Tan C, Rodriguez ER, Schoenhagen P, Flamm SD, Rodriguez LL, Svensson LG, Griffin BP. Sinus of Valsalva Aneurysms: A State-of-the-Art Imaging Review. J Am Soc Echocardiogr 2020; 33:295-312. [PMID: 32143779 DOI: 10.1016/j.echo.2019.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/18/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022]
Abstract
Cardiovascular imaging has an important role in the assessment and management of aortic root and thoracic aorta ectasia and aneurysms. Sinus of Valsalva aneurysms are rare entities. Unique complications associated with sinus of Valsalva aneurysms make them different from traditional aortic root aneurysms. Established guidelines on the diagnosis and management of sinus of Valsalva aneurysms are lacking. This article reviews the applications of multimodality cardiovascular imaging (echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging) for the dedicated assessment and imaging-guided management of sinus of Valsalva aneurysms.
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Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Duygu Kocyigit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Carmela Tan
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, Ohio
| | - E Rene Rodriguez
- Department of Cardiovascular Anatomical Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott D Flamm
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - L Leonardo Rodriguez
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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27
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Burch M, Kapur S, Starnes S. Lung Cancer Screening: Insights from a Thriving Clinical Practice. CURRENT PULMONOLOGY REPORTS 2019. [DOI: 10.1007/s13665-019-00231-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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28
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Evangelista A, Maldonado G, Moral S, Teixido-Tura G, Lopez A, Cuellar H, Rodriguez-Palomares J. Intramural hematoma and penetrating ulcer in the descending aorta: differences and similarities. Ann Cardiothorac Surg 2019; 8:456-470. [PMID: 31463208 DOI: 10.21037/acs.2019.07.05] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Acute aortic syndromes include a variety of overlapping clinical and anatomic diseases. Intramural hematoma (IMH), penetrating atherosclerotic ulcer (PAU), and aortic dissection can occur as isolated processes or can be found in association. All these entities are potentially life threatening, so prompt diagnosis and treatment is of paramount importance. IMH and PAU affect patients with atherosclerotic risk factors and are located in the descending aorta in 60-70% of cases. IMH diagnosis can be correctly made in most cases. Aortic ulcer is a morphologic entity which comprises several entities-the differential diagnosis includes PAU, focal intimal disruptions (FID) in the context of IMH evolution and ulcerated atherosclerotic plaque. The pathophysiologic mechanism, evolution and prognosis differ somewhat between these entities. However, most PAU are diagnosed incidentally outside the acute phase. Persistent pain despite medical treatment, hemodynamic instability, maximum aortic diameter (MAD) >55 mm, significant periaortic hemorrhage and FID in acute phase of IMH are predictors of acute-phase mortality. In these cases, TEVAR or open surgery should be considered. In non-complicated IMH or PAU, without significant aortic enlargement, strict control of cardiovascular risk factors and frequent follow-up imaging appears to be a safe management strategy.
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Affiliation(s)
- Arturo Evangelista
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, CIBER-CV, Barcelona, Spain.,Instituto del Corazón, Quironsalud Teknon, Barcelona, Spain
| | | | - Sergio Moral
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain
| | - Gisela Teixido-Tura
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Angela Lopez
- Servei de Cardiología, Hospital Universitari Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Hug Cuellar
- Institut Diagnostic per la Imatge, Hospital Vall d'Hebron, Barcelona, Spain
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30
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Golemati S, Patelaki E, Nikita KS. Image-Based Motion and Strain Estimation of the Vessel Wall. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/978-981-10-5092-3_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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31
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Raptis CA, McWilliams SR, Ratkowski KL, Broncano J, Green DB, Bhalla S. Mediastinal and Pleural MR Imaging: Practical Approach for Daily Practice. Radiographics 2018; 38:37-55. [PMID: 29320326 DOI: 10.1148/rg.2018170091] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Radiologists in any practice setting should be prepared to use thoracic magnetic resonance (MR) imaging for noncardiac and nonangiographic applications. This begins with understanding the sequence building blocks that can be used to design effective thoracic MR imaging protocols. In most instances, the sequences used in thoracic MR imaging are adapted from protocols used elsewhere in the body. Some modifications, including the addition of electrocardiographic gating or respiratory triggering, may be necessary for certain applications. Once protocols are in place, recognition of clinical scenarios in which thoracic MR imaging can provide value beyond other imaging modalities is essential. MR imaging is particularly beneficial in evaluating for benign features in indeterminate lesions. In lesions that are suspected to be composed of fluid, including mediastinal cysts and lesions composed of dilated lymphatics, MR imaging can confirm the presence of fluid and absence of suspicious enhancement. It can also be used to evaluate for intravoxel lipid, a finding seen in benign residual thymic tissue and thymic hyperplasia. Because of its excellent contrast resolution and potential for subtraction images, MR imaging can interrogate local treatment sites for the development of recurrent tumor on a background of post-treatment changes. In addition to characterization of lesions, thoracic MR imaging can be useful in surgical and treatment planning. By identifying nodular sites of enhancement or areas of diffusion restriction within cystic or necrotic lesions, MR imaging can be used to direct sites for biopsy. MR imaging can help evaluate for local tumor invasion with the application of "real-time" cine sequences to determine whether a lesion is adherent to an adjacent structure or surface. Finally, MR imaging is the modality of choice for imaging potential tumor thrombus. By understanding the role of MR imaging in these clinical scenarios, radiologists can increase the use of thoracic MR imaging for the benefit of improved decision making in the care of patients. ©RSNA, 2018.
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Affiliation(s)
- Constantine A Raptis
- From the Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (C.A.R., S.R.M., K.L.R., S.B.); Department of Radiology, Hospital Cruz Roja, Córdoba, Spain (J.B.); and Department of Radiology, Weill Medical College, New York-Presbyterian Hospital, New York, NY (D.B.G.)
| | - Sebastian R McWilliams
- From the Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (C.A.R., S.R.M., K.L.R., S.B.); Department of Radiology, Hospital Cruz Roja, Córdoba, Spain (J.B.); and Department of Radiology, Weill Medical College, New York-Presbyterian Hospital, New York, NY (D.B.G.)
| | - Kristy L Ratkowski
- From the Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (C.A.R., S.R.M., K.L.R., S.B.); Department of Radiology, Hospital Cruz Roja, Córdoba, Spain (J.B.); and Department of Radiology, Weill Medical College, New York-Presbyterian Hospital, New York, NY (D.B.G.)
| | - Jordi Broncano
- From the Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (C.A.R., S.R.M., K.L.R., S.B.); Department of Radiology, Hospital Cruz Roja, Córdoba, Spain (J.B.); and Department of Radiology, Weill Medical College, New York-Presbyterian Hospital, New York, NY (D.B.G.)
| | - Daniel B Green
- From the Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (C.A.R., S.R.M., K.L.R., S.B.); Department of Radiology, Hospital Cruz Roja, Córdoba, Spain (J.B.); and Department of Radiology, Weill Medical College, New York-Presbyterian Hospital, New York, NY (D.B.G.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (C.A.R., S.R.M., K.L.R., S.B.); Department of Radiology, Hospital Cruz Roja, Córdoba, Spain (J.B.); and Department of Radiology, Weill Medical College, New York-Presbyterian Hospital, New York, NY (D.B.G.)
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Kebed DT, Bois JP, Connolly HM, Scott CG, Bowen JM, Warrington KJ, Makol A, Greason KL, Schaff HV, Anavekar NS. Spectrum of Aortic Disease in the Giant Cell Arteritis Population. Am J Cardiol 2018; 121:501-508. [PMID: 29291886 DOI: 10.1016/j.amjcard.2017.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/01/2017] [Accepted: 11/07/2017] [Indexed: 01/12/2023]
Abstract
We report the spectrum of aortic involvement in patients with giant cell arteritis (GCA) following review of medical records of 4,006 patients including those with imaging studies. A total of 1,450 patients (36%) had a confirmed diagnosis of GCA. Of these, 974 had aortic imaging. Of the 974 patients with imaging, 435 (45%) had an identified aortopathy. The most common aortopathy was aneurysm/dilation (69%). Overall, an annual aneurysmal growth rate of 1.5 mm/y was calculated. In patients with aneurysm/dilation, aortic dissection occurred in 18 patients (6%), and these patients had a significantly higher aneurysmal growth rate compared with those without dissection (4.5 vs 1.4 mm/y, p = 0.005). The median size of the aorta at the time of dissection was 51 mm, with 7 (39%) occurring with a maximal aortic aneurysm/dilation <50 mm. In conclusion, our findings indicate higher aneurysmal growth rate in GCA compared with that reported for degenerative aortic disease. Moreover, patients who develop dissection had a significantly higher growth rate than those without dissection with over a third of these patients suffering dissection at a caliber <50 mm.
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Affiliation(s)
- Daniel T Kebed
- Rush University Medical Center, Department of Internal Medicine, Chicago, Illinois
| | - John P Bois
- Mayo Clinic Rochester, Division of Cardiovascular Disease, Rochester, Minnesota
| | - Heidi M Connolly
- Mayo Clinic Rochester, Division of Cardiovascular Disease, Rochester, Minnesota
| | - Christopher G Scott
- Mayo Clinic Rochester, Department of Biomedical Statistics and Informatics, Rochester, Minnesota
| | - Juan M Bowen
- Mayo Clinic Rochester, Division of Primary Care Internal Medicine, Rochester, Minnesota
| | | | - Ashima Makol
- Mayo Clinic Rochester, Division of Rheumatogy, Rochester, Minnesota
| | - Kevin L Greason
- Mayo Clinic Rochester, Division of Cardiovascular Surgery, Rochester, Minnesota
| | - Hartzell V Schaff
- Mayo Clinic Rochester, Division of Cardiovascular Surgery, Rochester, Minnesota
| | - Nandan S Anavekar
- Mayo Clinic Rochester, Division of Cardiovascular Disease, Rochester, Minnesota.
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Gifford JN, Poh ACC. Clinics in diagnostic imaging (182). Acute descending aortic dissection with aortic root retrograde extension. Singapore Med J 2017; 58:690-694. [PMID: 29242940 DOI: 10.11622/smedj.2017108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 77-year-old man presented with acute-onset severe chest pain radiating to the back and elevated blood pressure. Multiphasic computed tomography of the aorta revealed an intimal tear in the descending thoracic aorta which extended both retrograde to the aortic root and antegrade to the infra-renal abdominal aorta. The initial impression, that the images showed a Stanford type B aortic dissection, was because the portion of the false lumen that extended beyond the aortic arch remained unopacified even on delayed phases, making it challenging to assess the extent of the dissection flap. Bedside transthoracic echocardiography revealed a pericardial effusion. Cardiac tamponade ensued and the patient passed away shortly after presentation. This case highlights the need for early and accurate imaging assessment of acute aortic dissection, including accurate identification of the site of intimal tear and the extent of the dissection flap.
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34
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Gaeta R, Famà F. No pain, no gain … a diagnosis of acute aortic dissection. Am J Emerg Med 2017; 36:1309-1310. [PMID: 29162439 DOI: 10.1016/j.ajem.2017.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/13/2017] [Accepted: 11/13/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- Roberto Gaeta
- Cardiac Surgery, University Hospital of Messina, Italy; Consultant GUCH Cleveland Clinic Abu Dhabi, United Arab Emirates; Fellow of European Association for Cardio-Thoracic Surgery, United Kingdom
| | - Fausto Famà
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Italy.
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Pierce T, Hovnanian M, Hedgire S, Ghoshhajra B. Imaging of Cardiovascular Disease in Pregnancy and the Peripartum Period. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:94. [PMID: 29134367 DOI: 10.1007/s11936-017-0593-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OPINION STATEMENT Cardiovascular disease is an important cause of morbidity and mortality during pregnancy and the postpartum period. During pregnancy, the cardiovascular system undergoes extensive hemodynamic, hormonal, and microstructural changes which may exacerbate a preexisting underlying cardiovascular condition or predispose to cardiovascular complications not typically seen in young healthy women. Such conditions include spontaneous coronary artery dissection, atherosclerotic coronary artery disease, and peripartum cardiomyopathy. When evaluating this patient population, the diagnostic strategy should be tailored to specifically assess this distinct disease spectrum. The choice of imaging techniques must also consider potential risks to both the mother and child; a unique challenge of diagnostic imaging during pregnancy. The risk of radiation from radiography, computed tomography, and nuclear medicine imaging; iodinated and gadolinium-based contrast media for computed tomography and magnetic resonance imaging respectively; and heat deposition from sonography are of special importance during pregnancy. A thorough understanding of pregnancy-specific cardiovascular complications and the capabilities and risks of available diagnostic imaging modalities is crucial to appropriately manage the pregnant patient.
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Affiliation(s)
- Theodore Pierce
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Founders 216, Boston, MA, 02114, USA.
| | - Meline Hovnanian
- Department of Cardiothoracic Radiology, Mount Sinai School of Medicine - BISLR, 1000 Tenth Avenue, New York, NY, 10019, USA
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Brian Ghoshhajra
- Division of Cardiovascular Imaging, Massachusetts General Hospital - Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
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36
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Bonci G, Steigner ML, Hanley M, Braun AR, Desjardins B, Gaba RC, Gage KL, Matsumura JS, Roselli EE, Sella DM, Strax R, Verma N, Weiss CR, Dill KE. ACR Appropriateness Criteria® Thoracic Aorta Interventional Planning and Follow-Up. J Am Coll Radiol 2017; 14:S570-S583. [DOI: 10.1016/j.jacr.2017.08.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 12/11/2022]
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Weatherspoon K, Gilbertie W, Catanzano T. Emergency Computed Tomography Angiogram of the Chest, Abdomen, and Pelvis. Semin Ultrasound CT MR 2017; 38:370-383. [PMID: 28865527 DOI: 10.1053/j.sult.2017.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the setting of blunt trauma, the rapid assessment of internal injuries is essential to prevent potentially fatal outcomes. Computed tomography is a useful diagnostic tool for both screening and diagnosis. In addition to trauma, acute chest syndromes often warrant emergent computed tomographic angiography, looking for etiologies such as aortic aneurysms or complications of aortic aneurysms, or both, pulmonary emboli, as well as other acute vascular process like aortic dissection and Takayasu aortitis. With continued improvements in diagnostic imaging, computed tomographic angiography of the chest, abdominal and pelvis proves to be an effective modality to image the aorta and other major vascular structures.
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Affiliation(s)
- Kimberly Weatherspoon
- Department of Radiology, Baystate Medical Center-University of Massachusetts, Springfield, MA.
| | - Wayne Gilbertie
- Department of Radiology, Baystate Medical Center-University of Massachusetts, Springfield, MA
| | - Tara Catanzano
- Department of Radiology, Baystate Medical Center-University of Massachusetts, Springfield, MA
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38
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Zhao DL, Liu XD, Zhao CL, Zhou HT, Wang GK, Liang HW, Zhang JL. Multislice spiral CT angiography for evaluation of acute aortic syndrome. Echocardiography 2017; 34:1495-1499. [PMID: 28833419 DOI: 10.1111/echo.13663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To discuss the diagnostic value of multislice CT angiography (MSCTA) in acute aortic syndrome (AAS). MATERIALS AND METHODS The clinical and imaging data of 36 cases diagnosed as AAS by MSCTA were collected. The manifestations of the MSCTA images were reviewed retrospectively, and the average x-ray dose was calculated. RESULTS Among 36 AAS cases, 16 cases had aortic dissection (AD), 8 cases had penetrating atherosclerotic ulcer (PAU), 7 cases had intramural hematoma (IMH), and 5 cases had unstable thoracic aneurysm (UTA). Of 16 cases with AD, type A and type B accounted for 43.7% (7/16) and 56.3% (9/16), respectively. Of 7 cases with IMH, type A and type B accounted for 42.9% (3/7) and 57.1% (4/7), respectively. CONCLUSION In spite of the x-ray radiation, MSCTA proves to be a rapid and noninvasive imaging technique for the diagnosis of AAS.
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Affiliation(s)
- De-Li Zhao
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xin-Ding Liu
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Cheng-Lei Zhao
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hai-Ting Zhou
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guo-Kun Wang
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hong-Wei Liang
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jin-Ling Zhang
- Department of CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Wong HL, Liew CJY, Poh ACC. Saccular Kommerell aneurysm, a potential pitfall on MDCT imaging - A review of imaging features and potential mimics. Eur J Radiol Open 2017; 4:89-94. [PMID: 28861437 PMCID: PMC5569570 DOI: 10.1016/j.ejro.2017.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/25/2017] [Accepted: 06/26/2017] [Indexed: 11/15/2022] Open
Abstract
Kommerell aneurysm is an outpouching from a
kommerell diverticulum. Mimics include saccular aneurysm of the thoracic
aorta, ductus diverticulum and dilated Kommerell
diverticulum. Kommerell aneurysm has the tendency to rupture,
therefore, accurate diagnosis is critical.
Saccular Kommerell aneurysm represents a potential
pitfall on Multidetector CT (MDCT) imaging, mimicking conditions such as
saccular aneurysm of the thoracic aorta, ductus diverticulum and dilated
Kommerell diverticulum. Accurate diagnosis of this condition is critical in the
management of this potentially fatal condition. This paper reviews the MDCT
imaging features of Kommerell aneurysms and its mimics and demonstrates how to
make an accurate diagnosis through a series of four cases. MDCT features of
Kommerell aneurysms, either saccular or fusiform types arising from a Kommerell
diverticulum with atherosclerotic plaque and mural thrombus are
discussed.
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Affiliation(s)
- Hui Lin Wong
- Diagnostic Radiology, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
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40
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Long B, Koyfman A. Vascular Causes of Syncope: An Emergency Medicine Review. J Emerg Med 2017; 53:322-332. [PMID: 28662832 DOI: 10.1016/j.jemermed.2017.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 05/05/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Syncope is a common emergency department (ED) complaint, accounting for 2% of visits annually. A wide variety of etiologies can result in syncope, and vascular causes may be deadly. OBJECTIVE This review evaluates vascular causes of syncope and their evaluation and management in the ED. DISCUSSION Syncope is defined by a brief loss of consciousness with loss of postural tone and complete, spontaneous recovery without medical intervention. Causes include cardiac, vasovagal, orthostatic, neurologic, medication-related, and idiopathic, and most cases of syncope will not receive a specific diagnosis pertaining to the cause. Emergency physicians are most concerned with life-threatening causes such as dysrhythmia and obstruction, and electrocardiogram is a primary means of evaluation. However, vascular etiologies can result in patient morbidity and mortality. These conditions include pulmonary embolism, subclavian steal, aortic dissection, cerebrovascular disease, intracerebral hemorrhage, carotid/vertebral dissection, and abdominal aortic aneurysm. A focused history and physical examination can assist emergency physicians in determining the need for further testing and management. CONCLUSIONS Syncope is common and may be the result of a deadly condition. The emergency physician, through history and physical examination, can determine the need for further evaluation and resuscitation of these patients, with consideration of vascular etiologies of syncope.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
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Sazonov I, Khir AW, Hacham WS, Boileau E, Carson JM, van Loon R, Ferguson C, Nithiarasu P. A novel method for non-invasively detecting the severity and location of aortic aneurysms. Biomech Model Mechanobiol 2017; 16:1225-1242. [PMID: 28220320 PMCID: PMC5511604 DOI: 10.1007/s10237-017-0884-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 02/01/2017] [Indexed: 11/28/2022]
Abstract
The influence of an aortic aneurysm on blood flow waveforms is well established, but how to exploit this link for diagnostic purposes still remains challenging. This work uses a combination of experimental and computational modelling to study how aneurysms of various size affect the waveforms. Experimental studies are carried out on fusiform-type aneurysm models, and a comparison of results with those from a one-dimensional fluid–structure interaction model shows close agreement. Further mathematical analysis of these results allows the definition of several indicators that characterize the impact of an aneurysm on waveforms. These indicators are then further studied in a computational model of a systemic blood flow network. This demonstrates the methods’ ability to detect the location and severity of an aortic aneurysm through the analysis of flow waveforms in clinically accessible locations. Therefore, the proposed methodology shows a high potential for non-invasive aneurysm detectors/monitors.
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Affiliation(s)
- Igor Sazonov
- College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN, UK.
| | - Ashraf W Khir
- Brunel University London, Uxbridge, London, B8 3PH, UK
| | - Wisam S Hacham
- Brunel University London, Uxbridge, London, B8 3PH, UK.,Al-Khwarizmi College of Engineering, Baghdad University, Baghdad, Iraq
| | - Etienne Boileau
- College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN, UK
| | - Jason M Carson
- College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN, UK
| | - Raoul van Loon
- College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN, UK
| | - Colin Ferguson
- Department of Vascular Surgery ABMUHB, Morriston Hospital, Swansea, SA6 6NL, UK
| | - Perumal Nithiarasu
- College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN, UK
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Impact of Implementing Cardiac CT in Evaluating Patients Suspected of Cardioembolic Stroke. J Comput Assist Tomogr 2017; 40:380-6. [PMID: 26854417 DOI: 10.1097/rct.0000000000000369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES In practice, clinical and logistic hurdles may hamper performing transesophageal echocardiography in stroke patients. Cardiac computed tomography (CT) is a recently introduced noninvasive modality able to detect various embolic causes. Thus, we retrospectively assessed possible added values of applying cardiac CT in the real-world work-up of suspected cardioembolic stroke cases. METHODS Forty-seven patients were neurology service referrals for suspected cardioembolic stroke. The CT images and clinical reports of our cardiac CT radiologists were retrospectively evaluated. Cardiac CT was assessed in terms of detecting major embolic potential findings, potentially significant stroke-unrelated findings, and coronary arterial disease (CAD). Computed tomography results were correlated with echocardiographic reports. RESULTS Cardiac CT showed findings of major embolic potential in 10 patients (21%, 5 thrombi cases, 2 vasculitis cases, 1 case of metastasis invading the left superior pulmonary artery, 1 myocardial infarction case, and 1 pulmonary arteriovenous malformations case), none of which were documented in echocardiography reports. Two cases (4%) with findings of major embolic potential where identified on echocardiography but not on CT (1 left atrial appendage thrombus and 1 mitral valve vegetation). Computed tomography of 13 patients (28%) showed 16 potentially significant stroke-unrelated findings. Twenty-one patients (47%) had unexpected CAD on CT, 11 (52%) of which were obstructive. CONCLUSIONS Implementing cardiac CT in assessing patients suspected of cardioembolic stroke added value to echocardiographic evaluation, by detecting major embolic potential findings. In addition, cardiac CT revealed additional potentially significant stroke-unrelated findings and CAD.
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Chaturvedi A, Oppenheimer D, Rajiah P, Kaproth-Joslin KA, Chaturvedi A. Contrast opacification on thoracic CT angiography: challenges and solutions. Insights Imaging 2016; 8:127-140. [PMID: 27858323 PMCID: PMC5265191 DOI: 10.1007/s13244-016-0524-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/06/2016] [Accepted: 09/28/2016] [Indexed: 11/25/2022] Open
Abstract
Contrast flow and enhancement patterns seen on thoracic CT angiography (CTA) can often be challenging and may often reveal more than is immediately apparent. A non-diagnostic CTA following the initial contrast injection can be secondary to many causes; these include both extrinsic factors, such as injection technique/equipment failure (iv cannula, power injector), and intrinsic, patient-related factors. Contrast pressure and flow graphs often contain useful information regarding the etiology of a non-diagnostic scan. Understanding these graphs will help the radiologist plan a repeat contrast injection to overcome the deficiencies of the first injection and thus obtain a diagnostic scan. The current review article outlines normal and abnormal intravenous contrast dynamics, discusses how to recognize etiologies of non-diagnostic scans, and ultimately addresses techniques to overcome obstacles towards obtaining normal contrast opacification of the target vessel. In addition, there are some life-threatening findings, which unless sought for, may remain hidden in plain sight. Key Points • Using contrast enhancement and flow patterns to identify the cause of a non-diagnostic CTA. • Recognize life threatening causes of altered contrast dynamics such as cardiac asystole. • Non-target vessel opacification may hold key to underlying pathophysiology.
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Affiliation(s)
- Abhishek Chaturvedi
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, P.O. Box no. 648, Rochester, NY, 14642, USA.
| | - Daniel Oppenheimer
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, P.O. Box no. 648, Rochester, NY, 14642, USA
| | - Prabhakar Rajiah
- Department of Radiology, University of Texas Southwestern, Dallas, TX, USA
| | - Katherine A Kaproth-Joslin
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, P.O. Box no. 648, Rochester, NY, 14642, USA
| | - Apeksha Chaturvedi
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, P.O. Box no. 648, Rochester, NY, 14642, USA
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Qi Y, Ma X, Li G, Ma X, Wang Q, Yu D. Three-Dimensional Visualization and Imaging of the Entry Tear and Intimal Flap of Aortic Dissection Using CT Virtual Intravascular Endoscopy. PLoS One 2016; 11:e0164750. [PMID: 27760170 PMCID: PMC5070738 DOI: 10.1371/journal.pone.0164750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 10/02/2016] [Indexed: 01/02/2023] Open
Abstract
AIMS Conventional computed tomography (CT) approaches provides limited visualization of the entire endoluminal changes of aortic dissection (AD), which is essential for its treatment. As an important supplement, three-dimensional CT virtual intravascular endoscopy (VIE) can show relevant details. This study aims to determine the value of VIE in displaying the entry tear and intimal flap of AD. METHODS AND RESULTS Among 127 consecutive symptomatic patients with suspected AD who underwent CT angiography (CTA), 84 subjects were confirmed to have AD and were included in the study. Conventional CT and VIE images were observed and evaluated. From the 92 entry tears revealed via conventional CT, 88 (95.7%) tears appeared on VIE with round (n = 26), slit-shaped (n = 9), or irregular (n = 53) shapes, whereas the intimal flaps were sheetlike (n = 34), tubular (n = 34), wavelike (n = 13), or irregular (n = 7) in shape. The VIE also showed the spatial relationship between the torn flap and adjacent structures. Among 58 entry tears with multiple-line type flap shown on conventional CT, 41 (70.7%) appeared with an irregular shape on VIE, whereas among 30 tears with single-line type flap, 17 (56.7%) appeared as round or slit-shaped on VIE. These results demonstrated a significant difference (P < 0.05). The poor display of tears on VIE was related to the low CT attenuation values in lumen or in neighboring artifacts (P < 0.01). CONCLUSION CT VIE presents the complete configurations and details of the intimal tears and flaps of AD better than conventional CT approaches. Accordingly, it should be recommended as a necessary assessment tool for endovascular therapy and as part of strategy planning in pre-surgical patients.
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Affiliation(s)
- Yafei Qi
- Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Xiaoyuan Ma
- Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Gang Li
- Radiology Department, Jiaotong Hospital of Shandong Province, Jinan, Shandong Province, China
| | - Xiangxing Ma
- Radiology Department, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Qing Wang
- Radiology Department, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Dexin Yu
- Radiology Department, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
- * E-mail:
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Diagnostic performance of MDCT angiography in penetrating atherosclerotic aortic ulcer and its complications compared with digital subtraction angiography. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Reginelli A, Capasso R, Ciccone V, Croce MR, Di Grezia G, Carbone M, Maggialetti N, Barile A, Fonio P, Scialpi M, Brunese L. Usefulness of triphasic CT aortic angiography in acute and surveillance: Our experience in the assessment of acute aortic dissection and endoleak. Int J Surg 2016; 33 Suppl 1:S76-84. [DOI: 10.1016/j.ijsu.2016.05.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Kyaw H, Sadiq S, Chowdhury A, Gholamrezaee R, Yoe L. An uncommon cause of chest pain - penetrating atherosclerotic aortic ulcer. J Community Hosp Intern Med Perspect 2016; 6:31506. [PMID: 27406453 PMCID: PMC4942518 DOI: 10.3402/jchimp.v6.31506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 03/31/2016] [Accepted: 04/06/2016] [Indexed: 11/25/2022] Open
Abstract
Chest pain is a very common symptom and can be of cardiac or non-cardiac origin. It accounts for approximately 5.5 million annual emergency room visits in the United States, according to 2011 CDC data. Penetrating atherosclerotic aortic ulcer (PAU), an uncommon condition, is also a potential cause of chest pain. We here report the case of a 65-year-old woman who presented with atypical chest and back pain. The pain persisted for 4 weeks necessitating two emergency room visits. Initial tests were non-significant including cardiac troponins, an electrocardiogram (EKG), and a chest X-ray on her first visit. Upon her second visit, she underwent a computed tomography angiogram of chest with contrast which revealed a PAU with an intramural hematoma in descending aorta. The PAU was finally diagnosed with an exclusion of other chest pain causes. She was treated non-surgically with a blood pressure control strategy and pain management. After a 2-month period of smoking cessation and following the achievement of a controlled blood pressure, she felt well without chest pain.
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Affiliation(s)
- Htoo Kyaw
- Department of Internal Medicine, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA;
| | - Sanah Sadiq
- Department of Internal Medicine, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA
| | - Arnab Chowdhury
- Department of Internal Medicine, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA
| | - Rashin Gholamrezaee
- Department of Internal Medicine, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA
| | - Linus Yoe
- Department of Internal Medicine, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA
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Wielandner A, Beitzke D, Schernthaner R, Wolf F, Langenberger C, Stadler A, Loewe C. Is ECG triggering for motion artefact reduction in dual-source CT angiography of the ascending aorta still required with high-pitch scanning? The role of ECG-gating in high-pitch dual-source CT of the ascending aorta. Br J Radiol 2016; 89:20160174. [PMID: 27245139 DOI: 10.1259/bjr.20160174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: To compare electrocardiographic (ECG)-triggered high-pitch (HP) dual-source CT angiography (CTA) with non-ECG-triggered HP CTA of the aorta, particularly the ascending aorta, with regard to image quality, motion artefacts, contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR) and radiation dose. METHODS: 59 consecutive patients who had been referred for CTA for known or suspected aortic disease, previous aortic intervention or planned transapical or transfemoral aortic valve implantation were prospectively included. Patients underwent CTAs with HP, using a dual-source CTA system, with [control group (Group A); n = 30] or without (Group B; n = 29) ECG triggering after randomization. For evaluation, image quality and a motion artefact score (MAS) were assessed in a blinded fashion at different predefined anatomic regions. CNR and SNR were measured at the same levels. Radiation dose estimates and contrast enhancement were compared between the two groups. RESULTS: There were no significant differences for image quality and MAS. The intra-arterial contrast resolution was significantly higher at the level of the aortic arch and descending aorta in the non-triggered group (CNR values, p = 0.002-0.018). No significant differences in the radiation dose were found. CONCLUSION: Non-triggered HP dual-source CTA provided comparable results with regard to image quality, MAS, CNR, SNR and radiation doses compared with ECG-triggered HP CTA. Therefore, ECG triggering of the ascending aorta might be obviated when HP scanning is available. ADVANCES IN KNOWLEDGE: HP dual-source CTA might obviate ECG triggering in the ascending aorta. Non-triggered HP CTA of the ascending aorta provides an excellent image quality.
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Affiliation(s)
- Alice Wielandner
- 1 Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Dietrich Beitzke
- 1 Department of Radiology, Medical University of Vienna, Vienna, Austria
| | | | - Florian Wolf
- 1 Department of Radiology, Medical University of Vienna, Vienna, Austria
| | | | - Alfred Stadler
- 2 Department of Radiology, Krankenhaus Hietzing, Vienna, Austria
| | - Christian Loewe
- 1 Department of Radiology, Medical University of Vienna, Vienna, Austria
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