Chest CTA Research Articles

Abstract No. 414: Treatment of pulmonary artery stenosis with stents

1To become familiar with the causes and clinical presentation of pulmonary artery stenosis.2Describe the endovascular treatment for PA stenosis.3Develop awareness of the risks and pitfalls of endovascular treatment of the pulmonary artery. Pulmonary artery stenosis is a rare condition that can be a cause of severe hypoxemia, hypotension, and right heart failure. In adults, the most common etiologies of main or branch artery narrowing include: vasculitis, granulomatous disease, extrinsic mass compression, iatrogenic, and missed congenital etiologies. PA stent placement has been widely used in pediatric populations in the treatment of congenital stenosis. Adults presenting with signs of pulmonary artery stenosis often have cross sectional imaging to define the etiology and extent of the disease. Although not as commonly described, endovascular treatment of acquired PA stenosis can be used to relieve symptoms of pulmonary artery stenosis and provide relief to patients that are not surgical candidates or who wish to defer surgery. We will present three cases of PA stenosis that were managed with angioplasty and stent placement. Diagnostic CTA images will demonstrate the pathology and intraprocedural images will be used to describe the therapeutic techniques. A 66-year-old male who underwent a right-sided lung transplant six weeks prior and subsequently presented with increasing oxygen requirements. A CTA revealed a stricture at the anastomosis. A 28-year-old female presented with shortness of breath. Chest CT demonstrated mediastinal granulomatous disease causing extrinsic narrowing of the right main pulmonary artery. A 68-year-old female with known metastatic carcinoid presented with shortness of breath. Chest CTA demonstrated a large mediastinal mass causing near occlusion of the bilateral pulmonary arteries. Acquired pulmonary artery stenosis can lead to significant morbidity and mortality. Angioplasty and stent placement is a viable technique for management of PA stenosis.

60 Poster Moderated Gender Differences in Experiencing Chest Pain and CTA Findings in a Population without Previous CAD

60 Poster Moderated Gender Differences in Experiencing Chest Pain and CTA Findings in a Population without Previous CAD

Utility of CMR in monitoring of lung transplant recipients

Methods We enrolled 16 consecutive lung transplant recipients who were referred for CMR evaluation at The Methodist DeBakey Heart & Vascular Center (The Methodist Hospital, Houston, TX). Eight subjects were men and eight women; mean age 59.1 ± 9.2 years, 12 Caucasians, 2 Hispanic, 1 African American and 1 Asian. Six subjects had underlying restrictive (IPF), five had obstructive (COPD/ Emphysema/Cystic fibrosis), and three had other (BOOP/ hypersensitivity pneumonitis) disorders. Nine subjects had undergone double lung transplant while 7 subjects had single lung transplant, a mean of 17.9 ± 18.8 months prior to undergoing CMR imaging. The CMR protocol included complete short and long axis cine imaging using SSFP pulse sequences, spin echo imaging to assess pericardial thickness, contrast enhanced MRA of the pulmonary arterial and venous systems, phase contrast velocity flow mapping [for main, right and left pulmonary artery (PA) flows, and PA anastomotic site peak velocities]. All subjects underwent echocardiography, chest CTA, LPI and RHC as deemed necessary by their transplant pulmonologist. The records of all diagnostic tests were reviewed and compared with CMR findings.

Vascularisation systémique normale et pathologique du poumon : sémiologie tomodensitométrique

In most cases, treatment of life-threatening hemoptysis requires systemic arterial embolization, bronchial or not. Knowledge of the normal and pathological features of this systemic arterial network as depicted on multidetector row CTA, is an essential key because this examination has become the main imaging study prior to any interventional procedure. This article will review the indications for chest CTA, technical considerations and protocol in the evaluation of the systemic pulmonary circulation, as well as the imaging features of this circulation with emphasis on the normal and pathological imaging features to better correlate with the clinical presentation.

Angioscanner thoracique avec synchronisation ECG : évaluation dans le bilan d’une douleur thoracique atypique

The aim of this study was to evaluate ECG-gated whole chest CTA as a routine triage tool for patients with acute chest pain. Whole chest CTA with retrospective ECG-gating was performed in 30 patients with acute atypical chest pain. The ten main segments of the coronary arteries, the pulmonary arteries, the aorta, and the myocardium (function, morphology) were independently analyzed by a resident and two senior radiologists. The inter-observer agreement between resident and senior radiologists was calculated. A final diagnosis was determined by consensus. Thirty patients were included. The coronary artery segments, myocardium and pulmonary arteries were considered analyzable in 84%, 90% and 97% of cases respectively. A final diagnosis for the cause of pain was retained in 19 patients: significant coronary artery stenosis (5), pulmonary embolus (5), aortic dissection (1), hypokinetic cardiomyopathy (2), lung parenchymal abnormalities (5), and hiatus hernia (1). Inter-observer agreement ranged from 0.76 to 1 between senior radiologists and from 0.76 to 1 between resident and senior radiologists. The average time of image interpretation ranged from 14 to 15 minutes. ECG-gated whole chest CT angiography appears as a promising tool for the evaluation of acute chest pain. Combined evaluation of appearance and function of the myocardium can reveal additional interesting information.

ECG-gated chest CT angiography with 64-MDCT and tri-phasic IV contrast administration regimen in patients with acute non-specific chest pain

The purpose of this study was to evaluate chest CTA protocol using retrospective ECG-gating and triphasic IV contrast regimen for comprehensive evaluation of patients with acute non-specific chest pain. ECG-triggered dose modulation was used with a 64-MDCT scanner in 56 non-critically ill patients with acute nonspecific chest pain using triphasic IV regimen: 50 ml contrast followed by 50 ml 60% contrast/saline and 30 ml normal saline. Lungs, aorta, pulmonary and coronary arteries were graded on a 5-point scale (5, best). Aorta and pulmonary artery attenuation was measured and three coronary artery groups were evaluated. Comparison with invasive coronary angiography was obtained in nine patients on a per segment (16 total) basis. Dosimetry values were obtained. Studies were satisfactory in all patients (score >3). Aorta and pulmonary artery attenuation was >200 HU in 90.5%. Lung or pleura, non-cardiac vascular and coronary arteries disease were detected in 20, 11 and 16 patients, respectively. Median coronary angiography (grade 5) was significantly higher than acceptable for diagnosis grade 4 (p < 0.001). Per segment, weighted kappa statistic was 0.79 indicating substantial agreement with catheter angiography (p<0.001). Average DLP was 1,490 +/- 412 mGy-cm. Gated 64-MDCT angiography with triphasic IV contrast is a robust multipurpose technique for patients with acute non-specific chest pain.

Surgically palliated double-inlet left ventricle with transposition of the great arteries mistaken for aortic aneurysm with dissection

We report a 23-year-old male with history of double-inlet single ventricle with transposition of the great arteries who is s/p pulmonary artery banding, a Damus–Kaye–Stanzel anastomosis, and Fontan procedure during infancy and childhood who now presents with chest pain. A chest CTA at an outside hospital was thought concerning for the presence of a thoracic aortic aneurysm with dissection, prompting immediate transfer to our institution. However, repeat chest CTA at our institution revealed the predicted anastomoses based on his surgical procedures, which was misinterpreted as aortic aneurysm and dissection. An understanding of the physiology of his surgically repaired congenital heart disease is critical in interpreting his subsequent chest CTA and arriving at the appropriate clinical conclusion.

OPTIMIZING EMERGENCY DETECTION OF BLUNT TRAUMATIC AORTIC INJURY.

Blunt traumatic injury to the thoracic aorta is a common and deadly consequence of motor vehicle collisions and falls from significant heights. A relatively simple detection algorithm for traumatic aortic injury has been developed at Harborview Medical Center. This algorithm relies on the initial chest radiograph (CXR) to inform the decision of whether to proceed to chest computed tomographic angiogram (chest CTA) or catheter angiography (CA). In an attempt to improve this algorithm, Blackmore et al developed a clinical prediction rule to determine the probability of aortic injury based on a number of clinically evident risk factors. The probability of injury can then further inform the decision of whether to proceed to more sensitive and specific, yet more costly, invasive and time-intensive imaging modalities. The purpose of the present study was to (1) evaluate the current detection algorithm and (2) validate the previously developed clinical prediction rule. A 3-year single-institution retrospective case-control study with 25 cases of aortic injury and 181 controls was conducted. Chart review was performed for each subject, and the effectiveness and efficiency of the current imaging algorithm were determined. The detection algorithm correctly identified 96% of all cases of aortic injury. A definitive diagnosis was established within 12 hours for 88% of the patients. However, only 1 in 400 CXRs lead to a positive diagnosis of aortic injury, suggesting that much energy is invested in screening an injury that is relatively rare. Compared with the previous clinical prediction rule only four of the seven composite risk factors were significant predictors of aortic injury. The probability of injury ranged from 0 with no risk factors to 1.8% with three or four risk factors. Since this is not a clinically useful range of probabilities, the previously developed clinical prediction rule cannot be used to stratify patients according to probability of injury and thus cannot be used to inform the current detection algorithm. Any future clinical prediction rule that is developed must either consider different clinical factors or include a greater number of cases to increase the power of the study in the hope of elucidating a greater number of significant predictors. Until that time, the CXR-based detection algorithm appears to be a highly effective, albeit marginally efficient, method for detecting traumatic aortic injury.

Stent‐graft Treatment for Isolated Infrarenal Aortic Dissecting Aneurysms

We report three cases of isolated infrarenal aortic dissecting aneurysms managed with stent-graft. Three patients, two men and one woman, with a mean age at diagnosis of 69 years were identified. In all cases, chest CT-A did not reveal evidence of thoracic aortic dissection. The mean maximal aneurysm diameter was 6.7+/-1.5 cm (range: 5.5-8 cm). All patients underwent stent-graft repair. Follow-up computed tomographic (CT)-angiography examinations were scheduled 1, 4, and 12 months after the procedure. Stent-graft deployment was technically successful in all cases. Intraoperative mortality was not observed. All patients were adequately treated with a bifurcated device. Intensive care unit (ICU) stay was never required. Mean hospitalization was 4.6 days (range: 4-6 days). Mean follow-up was 18 months. No stent-graft-related complications were observed. Endovascular repair for isolated infrarenal abdominal aortic dissecting aneurysms is feasible and effective.

Computed tomography angiographic demonstration of a ventricular septal defect

1010-7940/$ see front matter q 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.ejcts.2004.06.024 Fig. 1. Post-processing ECG-gated chest CTA was performed on a 16 channel multid 16 Medical, Milwaukee, WI). (A) Axial 2D image at the mid-ventricular level demon Dissection flap with a large fenestration in the distal descending thoracic aorta is also reconstructed at the mid diastolic phase of the cardiac cycle (4D imaging) clearly de grafts used to replace the ascending aorta and the arch with elephant trunk techn reconstructed at the mid-systolic phase of the cardiac cycle demonstrates contrac (closed arrow). Dissection flap in the distal descending thoracic aorta is also denot