Characteristics of Atherosclerotic Plaque in Thoracic Aorta in the Elderly Evaluated by Magnetic Resonance Vessel Wall Imaging / 中国医学影像学杂志

Purpose The thoracic aortic atherosclerotic plaque is an important source of ischemic stroke embolism in the elderly.This study aims to explore the characteristics of vulnerable plaque of atherosclerosis in the thoracic aorta in the elderly by using three-dimensional multi-contrast magnetic resonancewall imaging technique,so as to actively prevent the occurrence of cardiovascular and cerebrovascular complications.Materials and Methods Fifty-three cases of elderly subjects (＞60 years old) without serious cerebrovascular diseases were recruited in this prospective study.All subjects were divided into A and B groups (60-74 and 75-90 years old).All subjects underwent MRI of multiple contrast sequences of the aortic wall.The thoracic aorta was divided into three segments of ascending aorta,aortic arch and descending aorta,and the characteristics of the atherosclerotic plaque were evaluated.The load characteristics of thoracic aortic atherosclerotic plaques in the elderly were calculated quantitatively,and the compositional characteristics were evaluated qualitatively.Results The incidence of intraplaque hemorrhage in the thoracic aortic atherosclerotic plaque in the elderly was 26.4％ (14/53),and the incidence of lipid nucleus was 94.3％ (50/53).Meanwhile,the maximum wall thickness of three segments of ascending aorta,aortic arch and descending aorta in group B was significantly higher than that in group A [(3.1±0.6) mm vs (3.0±0.4) mm,P＜0.05;(3.2±0.7) mm vs (3.1 ±0.7) mm,P＜0.05;(3.0±0.8) mm vs (2.9±0.7) mm,P＜0.001];the normalized wall index of the three segments in group B was significantly higher than that in group A [(26.9±3.5)％ vs (26.7±2.9)％,P＜0.001;(31.9±5.1)％ vs (31.0±5.1)％,P＜0.001;(34.6±5.0)％ vs (34.1 ±4.6)％,P＜0.001)].Conclusion The incidence of hemorrhage in the atherosclerotic plaque in the thoracic aorta in the elderly is higher,and the plaque load increases with age.Therefore,early screening of vulnerable plaque in the thoracic aorta in the elderly using magnetic resonance wall imaging will be helpful for prevention and treatment of stroke.

Triple-rule-out Computed Tomographic Angiography Using Adaptive Prospective ECG Triggering / 中国医学影像学杂志

Purpose To evaluate the clinical value of triple-rule-out (TRO) computed tomographic angiography using adaptive prospective ECG triggering for chest pain patients.Materials and Methods Sixty patients with chest pain were prospectively collected and randomly divided into group A and group B:group A (n=30) performed prospectively gated axial scan and group B (n=30) performed retrospectively gated helical scan.The vascular density,noise and muscle density of the vessels including aorta,pulmonary artery,coronary artery between the two groups were measured and analyzed.The vascular density/noise ratio,contrast noise ratio and effective dose (ED) between the two groups were calculated.The image quality and scanning radiation dose were compared between the two groups.Results There was no significant difference in the image quality of aorta,pulmonary artery and coronary artery between group A and group B (P＞0.05).The ED in group A was lower than that in group B [(5.90±2.10) mSv vs (11.31 ± 2.12) mSv,P＜0.01].Conclusion The technique of TRO computed tomographic angiography triggered by adaptive prospective ECG can significantly reduce the radiation dose while ensuring image quality.

Measuring of Abdominal Aortic Aneurysm with Three-Dimensional Computed Tomography Reconstruction before Endovascular Aortic Aneurysm Repair

PURPOSE: Conventional computed tomography (CT) is the gold standard method for case planning for endovascular aortic aneurysm repair (EVAR). However, aortography with a marking catheter is needed for measuring the actual length of an aneurysm. With advances in imaging technology, a 3-dimensional (3D) workstation can obviate the need for the aortography. The objective of this study was to determine whether a 3D workstation could obviate the need for aortography for EVAR. MATERIALS AND METHODS: One vascular surgeon and 1 interventional radiologist retrospectively assessed axial CT scans and reformatted the 3D CT scans by using the iNtuition workstation (TeraRecon Inc., San Mateo, CA, USA) for 25 patients who underwent EVAR. Four measurements of diameter and length were obtained from each modality. The actual length of an aneurysm for the proper graft was decided by 2 observers by reviewing the aortography with a marking catheter. RESULTS: The measurements from the 2 modalities were reproducible with intraobserver correlation coefficients of 0.89 to 1.0 for conventional CT and 0.98 to 1.0 for 3D workstation. Interobserver correlation coefficients were 0.29 to 0.95 for conventional CT and 0.85 to 0.99 for the 3D workstation. The length of the aneurysm for proper main graft coincided in 18 and 14 patients according to the conventional CT scan and in 21 and 18 patients according to the 3D workstation, respectively. CONCLUSION: The interobserver agreement in planning EVAR was significantly better with the iNtuition 3D workstation. But aortography with a marking catheter may still be needed for selecting the proper graft.

Hombre de 65 años con dolor lumbar crónico y cambios en la aortografía / A 65-year-old man with chronic lumbar pain and changes in aortography

A 65-year-old male with medical history of hyperlipidemia, type 2 diabetes mellitus, and arterial hypertension well controlled by glibenclamide, and amlodipine plus enalapril for about a decade was referred to our service because of the recent fndings in aortography (Figure 1: A, B, and C). He was not a smoker, neither a heavy alcohol drinker, and had chronic lumbar pain related to degenerative spondyloarthropathy. Previous imaging studies had showed narrowing of the disc space and reduction of the diameter of spinal canal on L4 and L5. During evaluation of control, an incidental image was observed in the right side of his pelvis, and the aortography was done. On presentation, BMI was 33 kg/m2, temperature was 36°C, blood pressure was 120x80 mmHg, with 80 bpm and 14 irpm, and there were no signifcant physical fndings on abdominal region. Laboratory fndings (normal ranges) revealed unremarkable blood counts and thyroid function; total cholesterol 289 (<200 mg/dL), HDL 54 (30-60 mg/ dL), LDL 206 (100-190 mg/dL), and tryglicerides 147 (<180 mg/dL); glucose 70 (70-99 mg/dL), uric acid 8.7 (2.5-7.0 mg/dL), urea 57 (14-50 mg/dL) with creatinine clearance 129.6 (≥129 ml/min); and PSA 0.5 (<4.0 ng/mL). After a successful open invasive procedure, he was discharged to outpatient.

Varón de 65 años con antecedentes médicos de hiperlipidemia, diabetes tipo 2. mellitus, e hipertensión arterial bien controlada por glibenclamida, y Amlodipine plus enalapril durante aproximadamente una década se refirió a nuestro servicio debido a los hallazgos recientes en aortografía (Figura 1: A, B y C). No era un fumador, ni un gran bebedor de alcohol, y tenía Dolor lumbar relacionado con espondiloartropatía degenerativa. Anterior Los estudios de imagen han mostrado estrechamiento del espacio discal y reducción. del diámetro del canal espinal en L4 y L5. Durante la evaluación del control, se observó una imagen incidental en el lado derecho de su pelvis, y la Se realizó una aortografía. En la presentación, el IMC fue de 33 kg / m2, temperatura. fue de 36 ° C, la presión arterial fue de 120x80 mmHg, con 80 bpm y 14 irpm, y no hubo hallazgos físicos significativos en la región abdominal. Los hallazgos de laboratorio (rangos normales) revelaron recuentos sanguíneos sin complicaciones y la función tiroidea; colesterol total 289 (<200 mg / dL), HDL 54 (30-60 mg / dL), LDL 206 (100-190 mg / dL) y tryglicerides 147 (<180 mg / dL); glucosa 70 (70-99 mg / dL), ácido úrico 8.7 (2.5-7.0 mg / dL), urea 57 (14-50 mg / dL) con aclaramiento de creatinina 129.6 (≥129 ml / min); y PSA 0.5 (<4.0 ng / mL). Después un procedimiento invasivo abierto exitoso, fue dado de alta como paciente ambulatorio

Endovascular Stent in Traumatic Thoracic Aortic Dissection

Traumatic thoracic aortic injury is typically fatal. However, recent improvements in pre-hospital care and diagnostic modalities have resulted in an increased number of patients with traumatic aortic injury arriving alive at the hospital. Also, the morbidity and mortality associated with endovascular repair are significantly lower than with conventional open surgery in traumatic thoracic aorta injury. We experienced two cases of successful management of traumatic thoracic aortic dissection with endovascular stents caused by traffic accidents.

Spontaneous rupture of an aneurysm of the sinus of Valsalva into the right atrium, associated with an atrial septal aneurysm / Ruptura espontánea de un aneurisma del seno de Valsalva a la aurícula derecha en una paciente con aneurisma del septum interatrial

Aneurysms of the sinus of Valsalva (SV) and the atrial septum are a rare association. We report the case of a 28-year-old woman, who was admitted to our department complaining of progressive dyspnea of 10 days of evolution, five hours previous to her admission to the hospital; she presented sudden oppressive anterior chest pain, accompanied by palpitations. The presence of rupture of the right SV to the right atrium was clinically confirmed, by echocardiography and hemodynamic studies. In addition, an associated atrial septal aneurysm was found. She underwent surgical correction through sinusplasty without requiring aortic valve replacement. The patient presented persistent postoperative atrioventricular block, which required a permanent pacemaker. Clinical evolution was satisfactory. To our knowledge, this case is a rare combination of two isolated malformations, without previous events that could explain the rupture of the right SV.

Los aneurismas del seno de Valsalva y del septum interauricular son una asociación rara. Informamos el caso de una mujer de 28 años de edad con un cuadro de disnea progresiva en los últimos 10 días, al cual se agregó dolor precordial opresivo, cinco horas previas a su ingreso. Se comprobó clínicamente, por ecocardiografía y hemodinamia la presencia de ruptura del seno de Valsalva derecho hacia el atrio derecho. Un hallazgo interesante fue la presencia de un aneurisma del septum interauricular asociado. La paciente fue sometida a corrección quirúrgica con plastía del seno de Valsalva, sin requerir reemplazo valvular aórtico. En el postoperatorio presentó bloqueo aurículo-ventricular persistente, requiriendo implante de marcapaso definitivo. Su evolución fue satisfactoria. Este es un caso de una rara asociación de dos malformaciones aisladas.

Avaliação da extensão da oclusão arterial na isquemia crônica de membros inferiores: estudo comparativo da ecografia com doppler colorido e da arteriografia / Assessment of the arterial occlusion extension in the lower extremity chronic ischemia: a comparative study of the duplex ultrasound and the arteriography

A arteriografia é um exame radiológico invasivo que permite ver as características da luz das artérias tronculares e de pequenos ramos musculares e colaterais, tornando possível constatar alterações parietais mínimas através da injeção intravascular de meio de contraste. Apesar do grande desenvolvimento tecnológico que experimentou nas últimas décadas, tem limitações para definir a extensão da obstrução e o leito arterial pósobstrução na Doença Arterial Oclusiva de Membros Inferiores (DAO). Alguns estudos já analisaram a arteriografia quanto à visibilização do leito distal em pacientes com DAO femoropoplítea, porém nenhum estudou a extensão do segmento ocluído no território aortoilíaco utilizando a arteriografia intra-operatória com injeção distal de contraste como teste padrão. Este estudo clínico, prospectivo, conduzido no Serviço de Cirurgia Vascular do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, foi desenvolvido para avaliar a arteriografia pré-operatória em sua capacidade de detectar a real extensão das oclusões arteriais, e o leito arterial distal a estas. A Ecografia com Doppler colorido também foi avaliada nesses mesmos aspectos. A extensão da oclusão foi definida como sendo a distância entre o ponto de oclusão e o ponto de reenchimento (PR) da luz arterial, e o leito distal (LD) definido como o conjunto de todas as artérias que mantêm continuidade com este ponto de reenchimento. Todos os pacientes incluídos foram submetidos, em mesmo intervalo determinado de tempo, a uma Arteriografia com injeção de meio de contraste Proximal à obstrução (AP), uma Ecografia com Doppler colorido (Eco-Doppler) e ao padrão-ouro para diagnóstico do PR e LD, que é a Arteriografia com injeção de contraste Distal à obstrução (AD). Foram estudados 47 membros inferiores, de 33 pacientes. Trinta e quatro casos de doença aortoilíaca e 13 casos de doença arterial infrainguinal femoropoplítea. A AP detectou o verdadeiro PR em apenas 53,2%...

Arteriography is an invasive method of imaging the vascular system that allows assessment of the intraluminal characteristics of the arteries. It detects minimal arterial wall changes with intravascular injections of contrast agents. Dispite significant advances in lasts decades, some pitfalls remain in determining the extension of arterial occlusions and the run-off vessels in cases of arterial occlusive disease in the lower extremities (LEAOD). Some authors have already studied the extension of the disease, by arteriography, in patients with femoropopliteal disease; nevertheless, none of them has so far used the Intraoperative Distal Prebypass Arteriography (IDA) as the goldstandard in patients with disease in the aortoiliac territory. This study is a clinical, prospective trial, developed by the Division of Vascular Surgery at the University of Sao Paulo to analyse the pre-operative arteriography (POA) in its capacity of showing the true extension of the arterial occlusion and the run-off vessels in LEAOD. The Duplex Ultrasound Arterial Mapping (DUAM) was also tested in the same situations. Extension of the arterial occlusion was defined as the length between the point where the contrast agent leaves the main vessel, and the point where the contrast come back to it, in the arterial system, the later called Refilling Point (RP). Run-off was defined as the sum of the distal arteries continuous with the RP. All of the patients included in this study were subjected in a determined time interval to a POA, a DUAM and a IDA. Forty seven lower extremities were studied in 33 patients (34 with aortoiliac, and 13 with femoropopliteal disease). POA detected the true RP in 53% of the instances, with a bad reprodutibility of the gold-standard (k = 0,44, P > 0,001). The DUAM detected the RP 74,5%, with a good results reprodutibliity (k = 0,68, P < 0,001). In the assessment of run-off vessels POA and DUAM have detected, respectively, 125 and 167 of the 183...

Takayasu's Arteritis Presented with Subarachnoid Hemorrhage: Report of Two Cases

Takayasu's arteritis is a chronic inflammatory disease that produces a narrowing of the aorta and its major branches. Fibrosis and thickening of the arterial wall often occur in later stages, resulting in a cerebrovascular accident. The authors report two young women patients who presented with subarachnoid hemorrhage (SAH) and occlusive cerebrovasular disease associated with Takayasu's arteritis. Both patients had sudden headache and hemiparesis. Physical examination showed weak radial pulse, carotid bruit, and asymmetrical blood pressure. Erythrocyte sedimentation rate (ESR) was elevated in both patients. SAH was confirmed by brain computerized tomography (CT) or lumbar puncture. Occlusive cerebrovascular disease was diagnosed by brain magnetic resonance imaging (MRI), brain magnetic resonance angiography (MRA), and cerebral angiography. The findings of aortography and cerebral angiography were compatible with Takayasu's arteritis, but intracranial aneurysm was not found in either patient.

Single-dose contrast-enhanced magnetic resonance aortography / 中华放射学杂志

Objective To probe the feasibility of single dose contrast enhanced magnetic resonance aortography(CEMRA) and evaluate its value in clinical application. Methods Transit time(TT) test and duration of peak enhancement of aorta(DPE) test in 28 healthy adults were performed. With 2 different injection rate of Gd DTPA at 2 ml/s and 3 ml/s, the TT,peak signal intensity of aorta(SPE),DPE and the interval between DPE and the time of injection(?T) were measured and compared. Two groups of healthy volunteers(each 10) underwent three diamentional fast imaging in static procession sequence (3D FISP) CEMRA with standard dosage of Gd DTPA with the injection rate at 2 ml/s and 3 ml/s respectively. The signal/noise ratio(SNR) of the source images and the image quality of CEMRA of both groups were compared. Fifteen patients with aortic disease did the same study as the voluteers with the injection rate only at 3 ml/s. Results With the injection rate of 2 ml/s and 3 ml/s,the TT,SPE,DPE,?T and the SNR of CEMRA in two groups were significantly different( P

Percutaneous Transluminal Angioplasty in Takayasu Arteritis: Complications and Results of Long-term Follow-up

PURPOSE: To evaluate the complications and results of long-term follow-up of percutaneous transluminalangioplasty(PTA) for the treatment of stenosis related to Takayasu arteritis. MATERIALS AND METHODS: Between December 1985 and August 1997, 21 patients(two men, 19 women; age range, 10-48 years) with Takayasu arteritis underwent PTA. There were 37 instances of stenosis(in 20 renal arteries, 10 descending aortas, 3 subclavianarteries, 3 common carotid arteries, and 1 axillary artery). In order to detect restenosis, all patients were followed up angiographically and clinically ; the period of this ranged from 8 to 121(mean 47) months. One or two redilatations were performed for restenotic arteries, and the complications and results of long-term follow-up were determined. In order to evaluate the effectiveness of PTA in Takayasu arteritis, primary and secondary patency were calculated by the Kaplan-Meier method. RESULTS: Among 37 stenotic vessels, 29 were sucessfully dialted and six partially so. Complications were aortic dissection(n=4) in aortic PTA, aortic dissection(n=1) inrenal PTA, intimal tears(n=6) in renal PTA, and hemorrhagic infart(n=1) in common carotid PTA. Restenosis occurred in 17 vessels(49%), and 12 vessels were restenosed within one year of PTA. Among 17 restenotic vessels, 14 were redilated with PTA, but after further PTA, five were restenosed. The Kaplan-Meier method showed primary patency of 62% one year after redilatation, and 46% five years after, while for secondary patency, the corresponding figures were 94% and 76%. CONCLUSION: In PTA of Takayasu arteritis, the possibility of restenosis is high, but redilatation can increase the patency rate. Intimal tearing, such as aortic dissection, may occur in PTA of Takayasu arteritis.

Counter-Current Aortography Using Peripheral Arteries in Small Infants and Neonates with Aortic Arch Obstruction

BACKGROUND: Diagnosis of aortic arch obstruction can be made with two-dimensional and Doppler echocardiography in most cases.However,not infrequently,clear imaging of the aortic arch can not be obtained,particularly in sick neonates and young infants from a number of reasons and heart catheterization and angiography carries significant risk in sick babies.Therefore it is the purpose of this study to assess the feasibility and safety of counter-current aortography through a peripheral artery in young infants and neotates with suspected aortic arch obstruction. METHOD: We studied 56 patients with suspected aortic arch anomaly at Asian Medical Center from Feburary 1990 to April 1997.First choice for the peripheral artery was radial artery on the same side as the aortic arch,followed by brachial artery and axillary artery.Small 24 gauge plastic cannula was inserted and special attention was given to ensure that the peripheral artery,plastic cannula,and a syringe containing contrast material are all in the same plane.1ml/kg of contrast material was injected by rapid hand injection and biplane cineangiograms were taken at 60 frame/second. RESULTS: Fifty six patients underwent 58 angiograms.Age ranged from 5-255 days(median 30 days) and body weight nanged from 2.1-5.4kg(mean3.4kg).There were 27 males and 29 females.Arteries used were:Radial artery in 37,brachal artery in 19,and axillary artery in 2 cases.Peripheral arteries were ipsilateral side as the aortic arch in 54,contralateral side in 2 and bilateral in 2 cases.In 8 patients heart catheterization was done because of inadequate visualization of aortic arch anatomy and/or need for evaluating other defects.In 48 patients who had periperal angiography only,fluoroscopic time ranged from 0.6 to 3.5 minutes and total procedure time ranged from 10 to 15 minutes.Among these 48 patients,only 11 patients(23%) were given intraveous sedation and 37 patients(77%) did not recieve any sedation.Diagnosis of aortic arch anomaly was aortic coarctation in 38,aortic interruption in 10 and nomal aortic arch in 8 patients.Aortic arch anatomy was well demonstrated in all cases where injected artery was on the same side as the aortic arch.In patients who had angiograms through peripheral arteries contralateral to the side of the aortic arch did not haveadequate visualization of the arch.Compression of the carotid artery did not enhance the imaging of the arch.Simultanous bilateral angiography did not improve the imaging quality as compared to ipsilateral artery angiography.Transient complication,related to cannulation,e.g.,prolonged bleeding was seen in only one patient with aortic interruption.Circulation on the upper extremities was normal after angiography in all patients. CONCLUSION: Counter-current aortography using 24 gauge plastic cannular through peripheral artery is feasible,rapid,safe,economic and relatevely non-invasive procedure and provides adquate imaging of aortic arch obstruction in infants and neonates without risk of heart catheterization and angiography.We,therefore,recommend this procedure in selected patients in whom echocardiographic imaging alone is not conclusive for planning corrective sursery.

A Case Report of Takayaeu's Arteritis Associated with, a Retinopathy

The authors have experienced a case of Takayasu's arteritis associated with Takayasu's retinopathy which is confirmed by aortography and fluorescent angiography in a 14 year old female.