ABSTRACT
AIMS: To study the relationship between left ventricular (LV) trabeculations, volume, and sphericity in patients with dilated cardiomyopathy (DCM) by cardiac magnetic resonance imaging (CMR). METHODS AND RESULTS: Eighty-two patients with DCM were prospectively explored by CMR. The segmental trabeculation index (STI) was defined by the ratio of trabeculated layer thickness on compacted layer thickness per segment. The global trabeculation index (GTI) was defined by the ratio of the sum of the total trabeculated layer thickness to the sum of the total compacted layer thickness. The apex was excluded from the analysis. The mean number of segments with trabeculation per patient was 10 ± 2 with a mean GTI of 0.68 ± 0.32. The LV sphericity index was inversely correlated with LV ejection fraction (R = -0.42, P = 0.0002) and positively with the brain natriuretic peptide (BNP) level (R = 0.34, P = 0.003). The maximal STI was positively correlated with the indexed LV end-diastolic volume (R = 0.32, P = 0.004) and the LV sphericity index (R = 0.25, P = 0.02), but not with the BNP level or LV ejection fraction. The GTI was positively correlated with the LV sphericity index (R = 0.27, P = 0.016) but not with indexed LV end-diastolic volume, BNP levels, or LV ejection fraction. CONCLUSION: Trabeculation indexes depend on LV shape and are positively correlated with LV sphericity. These results encourage interpreting LV trabeculation with caution in patients with DCM, considering additional morphologic criteria such as LV geometry.
Subject(s)
Cardiomyopathy, Dilated/physiopathology , Magnetic Resonance Imaging, Cine/methods , Ventricular Dysfunction, Left/physiopathology , Coronary Angiography , Echocardiography , Female , Humans , Image Interpretation, Computer-Assisted , Male , Middle Aged , Natriuretic Peptide, Brain/blood , Prospective StudiesABSTRACT
Although percutaneous transluminal renal angioplasty (PTRA) is associated with excellent results in medial fibromuscular dysplasia (FMD), the clinical and technical outcome in the less common nonmedial subtype of FMD is not clearly known. Angiographic PTRA results and clinical follow-up were documented, to report technical and clinical results in 30 patients with unifocal, nonmedial dysplastic stenoses. Balloon angioplasty was technically successful in only 65% of the lesions. Additional stenting, performed after PTRA failure in six patients, increased the initial technical success rate to 82%. Stenting was used in another lesion after restenosis, and long-term patency was achieved in only three of the seven stented lesions. Frequent restenoses and unusual complications were observed during follow-up. Stent fracture occurred in two cases. Overall, long-term clinical and technical successes were sustained in 70 and 76%, respectively. We conclude that nonmedial, unifocal renal artery dysplastic stenoses do not share the excellent prognosis of the medial type and that stenting should be avoided. Therefore, surgery should be considered in lesions remaining unresponsive to balloon dilatation, after a second PTRA attempt.
Subject(s)
Angioplasty, Balloon/methods , Angioplasty/methods , Fibromuscular Dysplasia/complications , Graft Occlusion, Vascular/surgery , Renal Artery Obstruction/therapy , Stents , Adolescent , Adult , Age Factors , Angiography/methods , Angioplasty, Balloon/instrumentation , Cohort Studies , Female , Fibromuscular Dysplasia/diagnostic imaging , Fibromuscular Dysplasia/pathology , Follow-Up Studies , Graft Occlusion, Vascular/diagnostic imaging , Humans , Male , Middle Aged , Probability , Renal Artery Obstruction/diagnostic imaging , Renal Artery Obstruction/etiology , Renal Artery Obstruction/surgery , Retrospective Studies , Risk Assessment , Sex Factors , Treatment Outcome , Vascular Patency/physiology , Young AdultABSTRACT
Thanks to recent advances, computed tomography is now seen as a tool of great value in the field of physical anthropology. In this study, we focused on the posterior pelvis and the auricular surface and evaluated the accuracy of 3D reconstructions of the auricular surface, using a methodology derived from a previous study by Lovejoy et al. We also looked for trabecular bone criteria expressing age-related changes. Forty-six coxal bones were scanned, and scoring of macroscopic criteria showed a good agreement between 3D reconstructions and photographs, especially for transverse organization (k = 0.90). The changes occurring in the posterior part of the sacropubic trabecular bundle were evaluated on CT reconstructions via three new criteria, which exhibited a good intra- and inter-observer agreement (k = 0.77-0.89), and were particularly useful in identifying older subjects. We concluded that these CT-evaluated trabecular bone criteria are promising and yield useful information about age at death.
Subject(s)
Age Determination by Skeleton/methods , Pelvic Bones/diagnostic imaging , Pelvic Bones/ultrastructure , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Feasibility Studies , Female , Forensic Anthropology/methods , Humans , Imaging, Three-Dimensional , Male , Middle AgedABSTRACT
Fistulas complicating an abdominal aortic aneurysm (AAA) are rare, and fistulas involving the left renal vein are particularly uncommon. We highlight here a fistula between an infrarenal aortic aneurysm and a retroaortic left renal vein, revealed by left flank pain associated with hematuria and acute renal failure. The multislice CT angiography performed in this 68-year-old patient revealed communication and equal enhancement between the aorta and the left gonadic vein, suggesting the presence of a fistula. The three-dimensional VRT reconstructions presented in this case were of great value in the preoperative planning, enabling immediate visualization of this unusual feature. Alternative diagnoses to consider when encountering this clinical presentation are reviewed.
