CT angiography in the assessment of carotid artery atherosclerosis.

OBJECTIVE: The aim of the study was to evaluate the ability of CT angiography (CTA) to detect atherosclerosis of the carotid arteries in comparison with 3D time-of-flight MR angiography (3D TOF MRA), using contrast angiography and intravascular ultrasound (IVUS) as a reference. MATERIAL AND METHODS: Contrast angiography and CTA were performed in 31 patients (mean age 65 years, range 45-79). The image quality was evaluated, atherosclerotic lesions were registered, and diameter stenosis degree was visually estimated from axial source images of CTA and 3D TOF MRA (21 patients), and results of interpretations were compared. The comparison of quantitative measurements was performed using IVUS as a reference. RESULTS: Contrast angiography detected 51 lesions (mean diameter stenosis 50%, range 10-100%), and CTA detected all same lesions. CTA provided better image quality and consistency of image interpretation than 3D TOF MRA. IVUS verified 29 atherosclerotic lesions with a mean diameter stenosis of 35%, (range 4-40%). CTA yielded a sensitivity of 96% to 100% (< or =10% or < or =20% diameter stenosis regarded as normal) for the detection of lesions with reference to IVUS. CONCLUSION: CTA seems feasible and accurate for the detection of atherosclerosis in carotid arteries.

Angiographically guided utero-placental gene transfer in rabbits with adenoviruses, plasmid/liposomes and plasmid/polyethyleneimine complexes.

We examined the feasibility of gene transfer to rabbit placenta using adenoviruses, plasmid/liposomes and plasmid/polyethyleneimine (PEI) complexes. Pregnant New Zealand White rabbits (n = 17) were anesthetized and local gene transfer was done via a catheter inserted in uterine arteries under direct angiographic control. Either nuclear targeted LacZ adenoviruses (1.0 x 10(10) p.f.u.), nuclear targeted LacZ plasmid (500 microg)/liposome (DOTMA:DOPE 1:1) complexes or nuclear targeted LacZ plasmid (250 microg)/PEI (25 kDa) complexes (charge ratio +/-4) were used. Animals were killed 3 days later and detection of the transgene expression was done by X-gal staining and RT-PCR. Adenovirus-mediated gene transfer resulted in a high transfection efficiency (34 +/- 10%) in placental trophoplastic cells. Very little, if any, transfection was seen in fetal membranes. Plasmid/liposomes and plasmid/PEI complexes led to a very low (<0.01%) transfection efficiency in trophoblastic cells, but some transfection was seen in fetal membranes. A total of 25 fetuses were analyzed for the presence of transgene at the time of death. In most fetuses expression of the LacZ gene was below the sensitivity of the X-gal staining, but expression was detected by PCR in 50%, 50% and 42% of the analyzed fetuses after adenoviral, plasmid/PEI and plasmid/liposome gene transfer, respectively. No major inflammatory changes were present in the transfected placentas as analyzed by general histology and macrophage- and T cell-specific immunostainings. We conclude that catheter-mediated intravascular gene transfer with adenoviruses can be used for the transfection of placental trophoplastic cells, but plasmid complexes are inefficient for this purpose. However, selective angiographically guided gene transfer also led to leakage of the vector to fetuses. Therefore, if gene therapy is developed for the treatment of placental disorders, the gene-vector combination should not be harmful to the fetus and the expression of the transgene should only occur in placenta.

Intravascular ultrasound in interventional radiology.

Intravascular ultrasound (IVUS) imaging provides useful additional information to X-ray angiography in selected cases of balloon angioplasty and stent placement with complex vascular anatomy and unclear findings at angiography. It facilitates accurate measurements of the vessel dimensions and reveals the extent of the disease for the selection of proper angioplasty balloon size, as well as confirms full expansion and attachment of the stent or stent graft to the arterial wall. Intravascular US imagining contributes useful information for the basis of planning surgical or endovascular therapy of aortic dissection and is valuable for guiding percutaneous fenestration of the dissection flap. This imaging modality facilitates placement of vena cava filter without cavography and/or fluoroscopy in patients with contraindication for iodine contrast media and/or X-ray fluoroscopy. Technical development may further increase utility of IVUS imaging in interventional radiology.

Prospective trial of infrapopliteal artery balloon angioplasty for critical limb ischemia: angiographic and clinical results.

PURPOSE: To evaluate the safety and efficacy of infrapopliteal percutaneous transluminal angioplasty (PTA) as a primary treatment of chronic critical limb ischemia in a prospective trial. MATERIALS AND METHODS: Infrapopliteal PTA was performed on 72 limbs of 60 patients (mean age, 72 y; range, 38-92 y) and patients were followed for 12-24 months. RESULTS: The primary angiographic success rate for the stenoses was 84% (102 of 121) and that for the occlusions was 61% (41 of 67) with corresponding restenosis rates of 32% and 52% at follow-up angiography performed a mean of 10 months after primary PTA. The rate of major complications was 2.8% (access site pseudoaneurysms in two patients). The primary clinical success was 63% (45 of 72). A 48% cumulative primary patency rate, a 56% secondary patency rate, and a 80% cumulative limb salvage rate were registered at 18 months, as determined with use of Kaplan-Meier analysis. Lack of angiographic improvement at the site of the most severe ischemia and renal insufficiency (serum creatinine level > 130 micromol/L) were independent predictors of poorer long-term clinical results, as determined with use of Cox multiple regression analysis. CONCLUSIONS: Infrapopliteal PTA is a feasible primary treatment of chronic critical limb ischemia with moderate primary angiographic and clinical success, a low complication rate, and a cumulative limb salvage rate comparable with surgical techniques.

Stent placement versus percutaneous transluminal angioplasty of human carotid arteries in cadavers in situ: distal embolization and findings at intravascular US, MR imaging and histopathologic analysis.

PURPOSE: To compare endovascular stent placement with percutaneous transluminal angioplasty (PTA) of carotid arteries with respect to distal embolization and findings at intravascular ultrasonography (US), magnetic resonance (MR) imaging, and histopathologic analysis. MATERIALS AND METHODS: PTA was performed in situ in one carotid artery, and stent placement was performed in the other, in ten cadavers (age range, 57-82 years; mean age, 68 years) with severe atherosclerosis by using fluoroscopic and intravascular US guidance. The carotid artery was connected to a pressurized tubing system in which a pulsatile pump circulated water. The effluent water was collected during the interventions, and after filtration and staining, the embolic material was analyzed histologically. After the interventions, the arteries were excised and 1.5-T spin-echo MR imaging was performed. RESULTS: No difference in severity of distal embolization during stent placement versus during PTA was found. The embolic particles were composed mainly of intimal strips and cellular constituents of the atherosclerotic plaques. MR imaging accurately depicted postinterventional changes, and the findings correlated closely with those of intravascular US and histopathologic analysis. CONCLUSION: Although stent placement and PTA were associated with equal distal embolization, the smooth surface and fully patent arterial lumen depicted at intravascular US and MR imaging postinterventionally may indicate that stent placement is preferable to PTA.

Mild carotid artery atherosclerosis: assessment by 3-dimensional time-of-flight magnetic resonance angiography, with reference to intravascular ultrasound imaging and contrast angiography.

BACKGROUND AND PURPOSE: Our aim was to evaluate the usefulness of 3-dimensional time-of-flight magnetic resonance angiography (3-D TOF MRA) in detection and quantification of mild atherosclerotic changes of carotid arteries with reference to intravascular ultrasound (IVUS) and contrast angiography. METHODS: TOF MRA at 1.5 T, IVUS, and selective digital subtraction angiography were performed on 31 extracranial carotid arteries of 27 patients (mean age, 52 years; age range, 17 to 75 years) undergoing neuroendovascular interventions. The atherosclerotic lesions were registered, and quantitative measurements of plaque thickness, luminal diameters, and diameter stenosis were independently performed for the imaging modalities. RESULTS: Among 170 arterial segments analyzed, IVUS revealed a total of 48 atherosclerotic lesions (mean diameter stenosis, 17%; range, 4% to 40%), only 25 of which were depicted on digital subtraction angiography. Analysis of the axial source images of TOF MRA resulted in sensitivity of 77% to 83% and specificity of 71% to 80% in lesion depiction for the 2 readers with reference to IVUS. The values of diameter stenosis measured from MRA and IVUS were closely interrelated (r=0.53 to 0.61, P<0.001). CONCLUSIONS: Three-dimensional TOF MRA is feasible and moderately accurate for evaluation of mild atherosclerotic changes of carotid arteries.

Intravascular ultrasound and magnetic resonance imaging in the assessment of atherosclerotic lesions in rabbit aorta. Correlation to histopathologic findings.

RATIONALE AND OBJECTIVES: The authors compare the usefulness of intravascular ultrasound (IVUS) and magnetic resonance imaging (MRI) for quantitation of atherosclerosis in hyperlipidemic rabbits, correlated with histopathology. METHODS: Magnetic resonance imaging with T1- and T2-weighted spin echo sequences and three-dimensional time-of-flight MR angiography of the abdominal aorta was performed on seven rabbits using a 1.5 T MR imager and a standard head coil. X-ray angiography and IVUS examination (3.5 F/30 MHz imaging catheter) was performed via carotid artery access. RESULTS: Time-of-flight MR angiography source images provided the best resolution and plaque-lumen contrast in visual comparison between the different MRI sequences. Intra- and interobserver reproducibilities of the lesion thickness and area measurements were similar in IVUS and MRI (Pearson correlations 0.52-0.97; P < 0.01). The measurements from IVUS and MRI correlated closely with each other as well as with those made from histopathologic specimens (Pearson correlations 0.50-0.79; P < 0.001). The measurements from IVUS were somewhat more accurate than those made from MRI. CONCLUSIONS: Both MRI and IVUS with clinically available imaging equipments are feasible and accurate for the quantitation of experimental atherosclerosis of rabbit aorta.

Human carotid arteries: correlation of intravascular US with angiographic and histopathologic findings.

PURPOSE: To establish the intravascular ultrasound (US) morphology of the arterial wall in various segments of the carotid artery and to evaluate atherosclerotic changes correlated with angiographic and in vitro histopathologic findings. MATERIALS AND METHODS: A total of 67 carotid arteries were imaged with a 3.5-F, 30-MHz intravascular US catheter: Twenty-four arteries were studied in vivo in 22 patients during neuroendovascular interventional procedures, in situ in 10 cadaveric arteries, and in vitro in 33 fresh excised arteries. RESULTS: In vivo, none of 10 calcifications and five (29%) of 17 intimal thickenings detected at intravascular US were seen at contrast material-enhanced angiography. At intravascular US, the arterial wall morphology was consistently three layered in the internal carotid artery above the bulb, either vaguely three layered or homogeneous in the bulb and in the carotid bifurcation, and homogeneous in the majority of common carotid arteries. The medial-adventitial interface was distinct in 21 (88%) of 24 arteries in vivo. Histopathologic and intravascular US classifications of the plaque agreed for 31 (82%) of the 38 arterial specimens in vitro. CONCLUSION: In vivo intravascular US was feasible in carotid arteries with mild atherosclerosis and often revealed intimal thickenings and concentric plaques in angiographically normal segments.

Diagnostic methods in dyspepsia: the usefulness of upper abdominal ultrasound and gastroscopy.

OBJECTIVES: To examine the diagnostic value of gastroscopy and upper abdominal ultrasound, which are frequently used as primary tests in dyspeptic patients in general practice. To test the influence of age for accuracy of both diagnostic methods. DESIGN: Clinical study. SETTING: Four health centres in Kuopio Province, Finland. SUBJECTS: Four hundred unselected consecutive dyspeptic patients (91 less than 45 years of age) who consulted their general practitioners. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive values (PV), efficiency and usefulness index (UI) were calculated for upper abdominal ultrasound and for gastroscopy in detecting the causes of dyspepsia in primary care. Final diagnosis was determined after one year follow-up. RESULTS: The sensitivity of upper abdominal ultrasound in detecting the cause of dyspepsia was 0.07, the specificity 0.91, PV+ 0.36, PV- 0.56, and UI -0.001. Ultrasound was not more efficient in older patients. Gastroscopy was the most efficient method with a sensitivity of 0.75, specificity 1.00, PV+ 0.99, PV- 0.83 and UI 0.56. The usefulness of gastroscopy was even better among patients over 45 years of age. CONCLUSIONS: The usefulness of upper abdominal ultrasound is low regardless of patient's age. Gastroscopy is superior to upper abdominal ultrasound as a first line diagnostic method in diagnosing dyspepsia, especially among patients over 45 years of age.

Rotator cuff calcifications: treatment with ultrasound-guided percutaneous needle aspiration and lavage.

OBJECTIVE: To analyze the results of ultrasound (US)-guided needle puncture, aspiration and lavage in the treatment of symptomatic calcific tendinitis of the rotator cuff. DESIGN AND PATIENTS: Atraumatic pain in 61 shoulders of 58 patients was resistant to conservative therapy. The average age of the treated patients was 42 years (range 26-49 years), follow-up was 12 months, and the mean diameter of the calcifications was 1.6 cm (range 1.1-2.9 cm). With US guidance and local anesthesia, two needles were placed within each calcification. The calcification was punctured 10-15 times and saline solution injected and aspirated using the needles until the aspirate was free of calcific particles. RESULTS AND CONCLUSIONS: Based on radiographs at 1 year follow-up. 74% (45 of 61) of the calcifications decreased, including 28% (17 of 61) which disappeared totally, and 26% (16 of 61) were unchanged. Calcifications with a faint or absent shadow on US proved to be nearly liquid (slurry calcification in 93% (14 of 15) of cases and could be aspirated. Clinical results were excellent in 74% (45 of 61), moderate in 16% (10 of 61) and poor in 10% (6 of 61) of cases. US offers technical advantages over fluoroscopy, and the typical US image of a slurry calcification helps to select the most suitable patients for aspiration treatment. The results are comparable with those using fluoroscopic guidance.

Etiology of dyspepsia: four hundred unselected consecutive patients in general practice.

BACKGROUND: Four hundred consecutive unselected patients with dyspepsia in health care centers were investigated. The aim of this study was to assess the frequency of various causes of dyspepsia in primary care and to evaluate the usefulness of the latest definition of functional dyspepsia. METHODS: Upper gastrointestinal endoscopy, upper abdominal ultrasound, a test for lactose intolerance, and basic laboratory screening were performed in every patient. RESULTS: Esophagitis was the cause of symptoms in 15%, symptomatic gastroesophageal reflux without esophagitis in 12%, duodenal ulcer in 9%, gastric ulcer in 4%, erosive duodenitis in 2%, lactose intolerance in 9%, gallstone disease in 2%, and malignancy in 2%. Other more infrequent causes of dyspepsia were giardiasis, celiac disease, erosive gastritis, and chronic pancreatitis. One hundred and thirty-five patients had functional dyspepsia with subgroups of ulcer-like (22%), dysmotility-like (28%), and nonspecific (50%). Irritable bowel syndrome was diagnosed in 37 patients (9%). CONCLUSIONS: The cause of dyspepsia was organic in 45%. Functional disorders, when symptomatic gastroesophageal reflux was included, were diagnosed in 55%. The latest classification of functional dyspepsia is not in accordance with the symptom complex.