Feeding arteries of the spinal cord at CT angiography before and after thoracic aortic endografting.

PURPOSE: To study the visualization of spinal cord feeding arteries in patients with complex thoracic aortic pathology undergoing endovascular aortic repair (EVAR) using an optimized protocol for multislice computed tomographic angiography (MSCTA). METHODS: Eighteen consecutive patients (13 men; mean age 63 years, range 45-79) with aortic type B dissections (n=5), chronic expanding aortic dissections (n=5), thoracic aortic aneurysms (n=6), or penetrating aortic ulcers (n=2) underwent 16-slice CTA before and after (mean interval 9 days) EVAR. Pulse rate and neurological status were documented. Quantitative density measurements were taken at regions of interest (ROI) in the ascending thoracic aorta and at the level of the diaphragm. Two experienced radiologists qualitatively assessed the posterior intercostal arteries (PIA; fully visible, partially visible, non-visible), dorsal branches (DB; visible/non-visible), and artery of Adamkiewicz (AKA; visible/non-visible) on multiplanar reformations and maximum intensity projection reconstructions. RESULTS: MSCTA was performed successfully in 17/18 patients before and after EVAR (1 patient was excluded after EVAR owing to rising creatinine levels). Before EVAR, MSCTA revealed 197/203 PIAs within the stented area, of which 179 were fully and 18 partially visible. No significant (p=0.37) difference was noted for overall PIA detection within the stented area on post-EVAR MSCTA (185/203 PIA), although only 124 were fully and 61 partially visible. Similar results were obtained for DB visualization. The AKA were seen in 10/17 patients pre EVAR and 9/17 post EVAR. In 2 patients, the AKA was localized within the stented aortic segment. ROI analysis revealed contrast densities of 427+/-89 HU and 398+/-84 HU on pre- and post-EVAR MSCTA, respectively. No neurological events were observed. CONCLUSION: The majority of posterior intercostal arteries and dorsal branches remain open after EVAR due to retrograde perfusion. High-resolution MSCTA permits accurate pre- and post-EVAR visualization of spinal cord feeding arteries in patients with thoracic aortic pathology.

Age related changes of human aortic distensibility: evaluation with ECG-gated CT.

Aortic distensibility is a parameter to grade vascular diseases and age-related effects because it is related to the elastic properties of the vessel wall. In this study vascular cross-sectional area changes have been determined using ECG-gated CT to analyse the age dependency of aortic distensibility. Distensibility measurements of the aorta were performed in 31 subjects (28 to 85 years). Time-resolved images were acquired either with a 4- or 16-detector row CT system using a modified CT angiography protocol. Cross-sectional area changes of the aorta were calculated by semiautomatic segmentation, and distensibility values were obtained using additional systemic blood pressure measurements. The aorta could be segmented successfully in all subjects. A decrease of aortic distensibility with age was found (r=0.50). Below (above) the renal arteries, the annual decrease was Delta D ( infrarenal ) =(-2.1+/-0.7).10(-7 )Pa(-1)a(-1), (D ( suprarenal ) Delta=(-3.5+/-1.1).10(-7 )Pa(-1)a(-1)). Differences between the ages, the youngest third and oldest third studied, were found to be significant (P( suprarenal )=0.003; P( infrarenal )=0.025). An age-dependent decrease of aortic wall elasticity can be determined in a modified routine CT angiography study.

Long-term outcome of operated inflammatory aortic aneurysms.

Inflammatory aortic aneurysms (IAAs) represent a rare form of aortic aneurysms. Compared with atherosclerotic aneurysms, patients with IAA have an increased risk of perioperative and long-term morbidity. This retrospective clinical study analyzed the outcome after conventional and endovascular repair of IAAs. Patients treated for an abdominal IAA between January 1995 and November 2004 were included. Imaging (computed tomographic angiography or magnetic resonance angiography) was performed preoperatively and at the time of follow-up (mean 2.7 years). Transperitoneal open repair and endovascular aortic repair were the operative procedures used. Over 10 years, 40 patients were treated with conventional and 5 patients with endovascular repair. The in-hospital morbidity rate was 11.1% (five patients; four conventional, one endovascular). On 10 patients (47.6%), the retroperitoneal fibrosis was no longer detectable. After operative repair, the majority of cases presented with a distinct regression of inflammation. Endovascular treatment of IAA represents a feasible alternative procedure to open aortic repair.

Complications after endovascular repair of acute symptomatic and chronic expanding Stanford type B aortic dissections.

OBJECTIVE: To outline the complications after endovascular repair in patients with acute symptomatic and chronic expanding Stanford type B aortic dissections. METHODS: Between 1997 and 2004, of 125 patients with acute and chronic aortic type B dissections, 88 were treated conservatively. Thirty-seven patients (29 male, mean age 58 years, range 30-82 years) underwent endovascular repair (30%) using 44 stent grafts of 3 different designs: Excluder (W. L. Gore & Associates, Inc, Flagstaff, Ariz), Talent (Medtronic Vascular, Santa Rosa, Calif), and Endofit (Endomed, Inc, Phoenix, Ariz). Indications for treatment were acute symptomatic type B dissection in 15 patients, chronic expanding aortic dissection greater than 55 mm in 14, rupture in 3, and simultaneous type A repair in 5 patients. Twenty-two operations were performed on an emergency basis. Patient characteristics, procedural variables, outcome, and complications were prospectively recorded. All patients underwent follow-up by computed tomography before discharge, at 6 and 12 months, and annually thereafter (mean follow-up: 24 months). RESULTS: Correct deployment was achieved in 97% of cases. There were no instances of primary conversion, paraplegia, or stroke. Complete false lumen thrombosis was observed in 11 patients (44%). Perioperative complication rate was 22%. Thirty-day mortality rate in acute and chronic dissections was 19% and 0%, respectively. Freedom from aortic reintervention was 81%, 73%, and 68%, freedom from late rupture was 97%, 90%, and 80%, and overall success rate was 76%, 65%, and 57% at 1, 2, and 5 years, respectively. Results for patients with chronic dissections are significantly (P = .038) better than results in those with acute dissections. CONCLUSIONS: Despite the minimally invasive approach, the complication and mortality rates for endovascular therapy of aortic dissections are still high. Frank reporting of these sequelae is if great importance to clarify the recent limitations of the method.

Quantification of aortic elasticity: development and experimental validation of a method using computed tomography.

Aortic distensibility depending on aortic cross-sectional area changes is an important parameter for the grading of vascular diseases. This study measured aortic area changes by multidetector computed tomography. An image reconstruction algorithm was developed to assess aorta diameter and area as a function of the cardiac cycle with sufficient time resolution along the entire length of the aorta by four-detector row computed tomography. The algorithm was tested on porcine aortic specimens and compared with an optical reference method. The error of the relative vessel area change comparing the two methods was found to be about 3%. Initial tests on patient datasets indicate that clinical application is feasible. The proposed method has the advantage that it can easily be integrated into a modified routine CT angiography study and allows the measurement of aortic cross-sectional area changes.

Comparing image quality of flat-panel chest radiography with storage phosphor radiography and film-screen radiography.

OBJECTIVE: To evaluate image quality of a large-area direct-readout flat-panel detector system in chest radiography, we conducted an observer preference study. A clinical comparative study was conducted of the flat-panel system versus the storage phosphor and standard film-screen systems. MATERIALS AND METHODS: Routine chest radiographs (posteroanterior) of 30 patients that were obtained using flat-panel, storage phosphor, and film screen systems were compared. The visibility of 10 anatomic regions and the overall image quality criteria were rated independently by three radiologists using a 5-point scale. The significance of the differences in diagnostic performance was tested with a Wilcoxon's signed rank test. Dose measurements for the three modalities were performed. RESULTS: The flat-panel radiography system showed an improved visibility in most anatomic structures when compared with a state-of-the-art conventional film-screen system and an equal visibility when compared with a storage phosphor system. The flat-panel system showed the greatest enhancement in the depiction of small detailed structures (p < 0.05) and achieved this with a reduction in overall radiation dose of more than 50%. CONCLUSION: The visibility of anatomic structures provided by this flat-panel detector system is as good as if not better than that provided by conventional or storage phosphor systems while emitting a reduced radiation dose.

Retained surgical sponge with migration into the duodenum and persistent duodenal fistula.

Migration of a retained surgical sponge into the bowel is a rare cause of bowel obstruction. Thus far, there have not been any reports that the site of initial migration of the sponge was identified by imaging studies or surgical exploration because the onset of symptoms is usually delayed. Unique about the case presented herein is that a barium meal follow-through study revealed a duodenal fistula that had developed after uneventful cholecystectomy due to a retained surgical sponge that had migrated into the duodenum and obstructed the distal jejunum. Imaging findings are presented and discussed.