Computed Tomography Angiography Findings Research Articles

Smartphone thermal imaging for preoperative perforator mapping in DIEP flap breast reconstruction

Perforator-based flaps have become a mainstay of autologous breast reconstruction practice. Despite available radiological investigations ranging from Doppler ultrasound (US) to CT angiography (CTA), finding and quantitatively assessing perforators remains a time-consuming, complex process. Infrared thermographic imaging (IRT) shows promise as a novel modality for preoperative localisation of perforator vessels. Thirteen women undergoing elective breast reconstruction with deep inferior epigastric artery perforator (DIEAP) flaps were recruited between August 2017 and July 2018. All had CTA and Doppler US mapping of arterial perforators preoperatively as standard. Additional abdominal thermal images were taken using a FLIR ONE smartphone compatible camera. Thermal hotspots were compared with Doppler markings and CTA findings. Twenty-six flaps were analysed. Seventy perforators were marked by Doppler US, with a mean of 2.92 perforators per flap (± SEM 0.15, SD 0.72). Forty (57%) had a corresponding hotspot on IRT. Overall, there was a statistically significant positive correlation between the number of perforators detected by Doppler US and IRT (r = 0.573, n = 26, p = 0.003) and kappa index 0.65. Eighty-four perforators were identified by CTA, with a mean of 3.5 perforators per flap (± SEM 0.14, SD 0.66). Fifty-eight (69%) had a corresponding hotspot on IRT. There was a statistically significant positive correlation between the number of perforators detected by CTA and IRT (r = 0.504, n = 26, p = 0.012) and kappa index 0.60. Thermography is an inexpensive, portable, non-invasive imaging technique, which shows statistically significant correlation to CTA and Doppler US in mapping perforators. Level of evidence: Level IV, diagnostic study.

Incidental COVID-19 related lung apical findings on stroke CTA during the COVID-19 pandemic

BackgroundAuthors have noticed an increase in lung apex abnormalities on CT angiography (CTA) of the head and neck performed for stroke workup during the coronavirus disease 2019 (COVID-19) pandemic.ObjectiveTo evaluate...

Evaluation of the Renal Arteries of 2,144 Living Kidney Donors Using Computed Tomography Angiography and Comparison with Intraoperative Findings

Objectives: A carefully chosen and suitably prepared kidney donor is essential in living-donor kidney transplantation. Computed tomography angiography (CTA) is an effective imaging method for evaluating the renovascular morphology of donor candidates. The aim of this study was to evaluate renal artery variations in kidney donors using CTA and compare the findings with the number of arteries detected during laparoscopic donor nephrectomy. Materials and Methods: The study included 2,144 living donors who underwent pretransplant renovascular assessment using CTA and laparoscopic donor nephrectomy in our center between August 2012 and October 2018. The number of renal arteries to the donor kidney detected on CTA was compared with the number of arteries discovered intraoperatively. Results: The mean age of the 2,144 living kidney donors included in the study was 47.19 ± 13.3 (18–87) years. According to CTA findings, 81.1% (n = 1,738) had a single renal artery, 17.2% (n = 369) had double renal arteries, 1.6% (n = 35) had triple renal arteries, and 0.1% (n = 2) had quadruple renal arteries. The same number of renal arteries were detected by CTA and in laparoscopic donor nephrectomy in 97.9% (n = 2,099) of the donors. In the other 2.1% (n = 45), fewer renal arteries were detected intraoperatively compared to their CTA findings. None of the donors included in the study had a greater number of renal arteries discovered during nephrectomy than by CTA. Conclusion: CTA is a highly accurate method for the evaluation of renovascular variations in donor candidates for living-donor kidney transplantation. However, it must be kept in mind that double or multiple renal artery variations may be detected on CTA in 18.9% of donor candidates.

On-site assessment of computed tomography-derived fractional flow reserve in comparison with myocardial perfusion imaging and invasive fractional flow reserve

Myocardial perfusion imaging (MPI) using Single Photon Emission Computed Tomography has been established as a standard noninvasive tool for risk stratification of coronary artery disease (CAD). We evaluated the diagnostic performance of on-site workstation-based computed tomography-derived fractional flow reserve (CT-FFR) in comparison with MPI using invasive fractional flow reserve (invasive FFR) as a gold standard. We enrolled 97 patients with suspected CAD. Diagnostic performance of CT angiography (CTA), and CT-FFR was compared in 105 lesions of 97 patients. Invasive FFR ≤ 0.8 was detected in 38 (36%) lesions. Diagnostic performance of CT-FFR was improved compared with CTA (AUC 0.83 vs. 0.60, p < 0.0001). The lesions with both CTA and MPI findings (n = 47), invasive FFR ≤ 0.8 was detected in 19 (40.4) lesions. CT-FFR (AUC 0.81, 95% CI 0.72-0.94) significantly improved diagnostic performance compared with CTA-50% (AUC 0.59, p = 0.00019) and MPI (AUC 0.64, p = 0.0082). In lesions with ≥ 50% on CTA (n = 42), diagnostic accuracy of CT-FFR (AUC 0.81) was significantly superior to MPI (AUC 0.64, p = 0.0239). In conclusions, CT-FFR improved diagnostic accuracy to detect invasive FFR ≤ 0.8 compared with luminal stenosis on CTA and ischemia on MPI. Patients with ≥ 50% stenosis on CTA would be the candidates for CT-FFR.

CT Angiography Findings Predictive of Kidney Injury in Chronic Aortic Dissection.

OBJECTIVE. The purpose of this study was to compare the volume alteration and effective renal plasma flow of kidneys supplied by false lumens (FLs) with those of kidneys supplied by true lumens (TLs), to show the discrepancy in perfusion between the two lumens. We sought to corroborate malperfusion of FL-supplied kidneys with imaging characteristics observed on CT angiography. MATERIALS AND METHODS. A retrospective analysis was conducted using prospectively collected data for 87 patients with a diagnosis of residual chronic aortic dissection between 2005 and 2013 who had one kidney perfused by a TL and the other kidney perfused by a FL. RESULTS. Overall, at follow-up, FL-supplied kidneys had a mean (± SD) effective renal plasma flow (117.5 ± 42.6 vs 146.6 ± 41.0 mL/min; p = 0.004) and volume (131.1 ± 37.1 vs 146.5 ± 33.3 cm3; p = 0.004) that were lower than those of TL-supplied kidneys. Multivariate analysis revealed the presence of a proximal major inlet (odds ratio, 0.306; 95% CI, 0.103-0.910; p = 0.033) and large FL area (odds ratio, 0.104; CI, 0.012-0.880; p = 0.038) as factors protecting against malperfusion of FL-supplied kidneys. In patients with dissected renal arteries, the FL-supplied kidney had low effective renal plasma flow (mean, 88.5 ± 26.8 vs 149.6 ± 43.5 mL/min; p = 0.004) and diminished volume (mean, 120.4 ± 30.4 vs 152.3 ± 24.6 cm3; p = 0.001). CONCLUSION. In the present study, kidneys perfused by FLs showed decreased volume and reduced effective renal plasma flow during follow-up, particularly those kidneys with dissected renal arteries, a small FL area at the renal level, and lack of a proximal major inlet. Further studies are warranted to identify the clinical relevance of malperfusion in FL-supplied kidneys.

CT Angiography Findings of Pulmonary Arteriovenous Malformations in Children and Young Adults With Hereditary Hemorrhagic Telangiectasia.

OBJECTIVE. The purpose of this study was to evaluate the CT angiography (CTA) findings of pulmonary arteriovenous malformation (PAVMs) in patients with hereditary hemorrhagic telangiectasia and to correlate these findings with those of graded contrast-enhanced transthoracic echocardiography (CE-TTE). MATERIALS AND METHODS. A retrospective review was conducted of PAVMs visualized at CTA of patients with abnormal CE-TTE findings (3-point scale). Location, distribution, size, number, volume, grade, and relative attenuation (attenuation of PAVM divided by attenuation of aorta) of PAVMs were recorded. PAVMs were graded as follows on conventional and maximum-intensity-projection (MIP) images: 0, nodule, unlikely PAVM; 1, ground-glass opacity (GGO); 2, GGO with increased vascular network; 3, GGO or nodule with single vessel; 4, GGO or nodule with two or more vessels; 5, GGO or nodule with afferent and larger efferent vessels; 6, mature arteriovenous malformation. Correlation between PAVM grade and relative attenuation and between CTA variables and CE-TTE grades was assessed. RESULTS. Forty patients (median age, 14.9 years; range, 0.6-27.9 years) had 117 PAVMs at CTA: 107 peripheral, eight central, and two both peripheral and central. None of the PAVMs was diffuse. Median size and volume were 0.4 cm (range, 0.1-4.4 cm) and 0.031 mL (range, 0.0009-10.019 mL). At CTA, seven PAVMs were grade 1, five grade 2, 28 grade 3, 62 grade 4, two grade 5, and 13 grade 6. MIP images showed 39 of 117 PAVMs were higher grade. Statistically significant correlation was found between relative attenuation and PAVM grade (p < 0.001, r = 0.58) in 40 patients and between all CTA variables and CE-TTE (p < 0.05, strongest correlation with highest grades [p < 0.0001, r = 0.81]) in 32 patients. CONCLUSION. In children and young adults with hereditary hemorrhagic telangiectasia, grade 4 PAVMs were most common. Higher-grade PAVMs more often have right-to-left shunts.

Variant Anatomy of the Renal Arteries: a Computed Tomography Angiography Study

The article discusses variant anatomy of the renal arteries, potentials of three-dimensional modeling and use of these data in clinical practice. Despite a large number of studies based on both morphological and clinical approaches there is no general consensus regarding options for dividing the renal artery, the number of its branches, their topolocalization. This is due to the fact that most of the research studies are based on cadaveric material, fixed and unfixed. It is difficult to apply these data to explain medical conditions and pathologies of particular patients. Computed tomography allows performing in vivo investigation of various morphometric parameters of the renal arteries, and these findings can subsequently be used in disease diagnostics and treatment.The aim of the study was to identify patterns of topography, linear dimensions and variant anatomy of the human renal arteries based on computed tomography angiography (CTA) with three-dimensional modeling, and to apply CTA findings in clinical practice.Material and methods. The study included CTA images of the abdomen of 130 patients, and their threedimensional models. A hardware-software complex "Luch-S" and software complex "Avtoplan" (Russian project) were used to perform morphometric analysis. The diameter of the renal artery mouth, the level of origin of the renal artery mouths, as well as the angles between the renal arteries and the abdominal aorta were analyzed morphometrically and statistically.Results. The authors have developed recommendations how to use three-dimensional modeling of vascular- organ complexes in patients at the stage of preoperative planning and intraoperative navigation in clinical practice. Generated dataset of personalized morphometric data can be applied to teach basic operation techniques involving possible damage to abnormal vessels, as well as training specific surgical procedures involving the kidney and its vessels in a simulation-based surgical clinic.

Use of Cardiac CT in the Routine Assessment of Cardiac Allograft Vasculopathy in Heart Transplant Patients: Results from the First 100 Consecutive Patients

Cardiac allograft vasculopathy (CAV) is an accelerated form of coronary artery disease that affects heart transplant patients (HTx). Routine screening for CAV is warranted. We evaluated the feasibility and utility of cardiac CT to screen for CAV in 100 consecutive HTx patients at our center. From Feb 2018 to Jan 2019 all consecutive HTxs who were more than five-years post-transplant were converted from using stress myocardial perfusion imaging to cardiac CT for the annual assessment of CAV. CAV was scored (0 (absent), 1 (mild), 2 (moderate), 3 (severe)) based on coronary CT angiography (CCTA) findings and compared with the most recently known CAV score before CCTA. CCTA was performed in 99 out of 100 patients who were planned for cardiac CT (56 (42-63) years, 65% men, and 11 (8-16) years post-transplant), 1 patient underwent only a calcium scan due to IV access problems. The median Agatston calcium score was 6 (0-85), and 38 patients had no detectable calcium. CCTA showed new obstructive coronary disease (>50% stenosis) in 20 patients. The CAV score was reclassified based on CCTA findings in 37 patients (p<0.001) (Figure 1). There were 53 CAV0, 22 CAV1, 11 CAV2 and 14 CAV3 patients. Mean heart rate during scanning was 75±11 beats per minute and beta-blockers were required in 63 patients. Median radiation dose was 2.5 (1.9-3.5) mSv. Two cases are presented in Figure 2. Cardiac CT can be successfully performed in HTxs with a low radiation dose. CCTA detects patients with significant coronary disease which leads to substantial reclassification of CAV grades.

CT angiography of lower extremities from anatomy to traumatic and nontraumatic lesions: a pictorial review.

After the introduction and the quick improvement of multidetector computed tomography technology, computed tomographic angiography (CTA) has become the imaging examination of choice for the first assessment of patients affected by lower extremities acute disorders. The widespread availability of CT equipment, the high temporal and spatial resolution with post-processing reformation possibilities represent the main advantages of this technique, which can reliably identify different findings related to arterial vessel pathology, such as occlusion, dissection, active bleeding, and pseudoaneurysm. Radiologists should know the anatomy, the acquisition protocols, and the CTA appearances of the different vascular lesions. The right interpretation of CTA findings is essential to establish the best treatment management of each patient.

Reliability of Multi-Detector CT in the Assessment of Mesenteric Ischemia Using Basic Images

Abstract Background: Mesenteric ischemia is caused by drop of blood flow in intestinal vasculature to a degree that compromise the viability of target part and according to the time and amount of reduction, it can be classified into acute mesenteric ischemia and chronic mesenteric ischemia. Aim of Study: To assess the value of Multidetector CT (MDCT) and CT Angiography (CTA) in the diagnosis of different causes of mesenteric ischemia using the source images and routine reformat. Material and Methods: This prospective study included 58 consecutive patients (30 males and 28 females), with age range (52-77 years) during the period from October 2017 to Dec. 2018. They were referred for CT angiography of the mesenteric vessels with clinical suspicious of (acute or chronic) mesenteric ischemia. Four patients were exclude due to contraindication to IV contrast, so finally the study was conducted for 54 patients, all underwent CT angiography and the results of CT angiography were collected and tabulated. Results: Twenty four subjects had CTA findings of me-senteric ischemia (acute=14 and chronic=10). Thickening of bowel wall was the commonest finding in Acute Mesenteric Ischemia (AMI) in 85.7%. Bowel wall non-enhancement was noted in 11 patients of 14 with AMI (78.57%). CTA pointed out the cause of AMI in 14 patients (dominant cause was arterial thromboembolism, (n=10 (71.4 %)), the most frequent site was Superior Mesenteric Artery (SMA). CTA diagnosed and found out the reason of pain in Chronic Mesenteric Ischemia (CMI) patients (atherosclerosis of the splanchnic arteries with significant stenosis or occlusion was the dominant reason (n=7, 70%). Among the 24 patients with mesenteric ischemia, MDCT and CTA provided the reason for mesenteric ischemia in all patients which represents accuracy, sensitivity and specificity of 100%. Conclusion: MDCT and CTA are noninvasive tools that can be the optimum choice in imaging of cases with suspicious mesenteric ischemia.

Endovascular Treatment Outcome and CT Angiography Findings in Acute Basilar Artery Occlusion with and without Underlying Intracranial Atherosclerotic Stenosis

PurposeTo compare clinical characteristics and treatment outcomes of intra-arterial thrombectomy (IAT) in acute basilar artery occlusion (BAO) with and without underlying intracranial atherosclerotic stenosis (ICAS) and to investigate the usefulness of preprocedural CT angiography findings in the diagnosis of ICAS. Materials and MethodsTwenty patients who received IAT for acute BAO between September 2014 and March 2019 were included. Additional therapies such as angioplasty, stent placement, and tirofiban infusion were provided while treating ICAS. Clinical and angiographic results of treatment were recorded. Preprocedural CT angiography findings in ICAS and non-ICAS groups were compared to assess (i) basilar tip opacification, (ii) partial occlusion, (iii) presence of convex border, (iv) occlusion segment longer than two thirds of the basilar artery or 20 mm, (v) dense basilar artery, and (vi) wall calcification in the occluded segment. ResultsAmong the 20 patients (mean age, 71.3 y; mean stroke score, 24.8), optimal recanalization was achieved in 19 (95%). Three patients had good clinical outcomes. There were 6 patients with underlying ICAS. No difference was observed between ICAS and non-ICAS groups in terms of optimal angiographic recanalization and good outcome. On CT angiography, basilar tip occlusion (100% vs 29%), partial occlusion (100% vs 83%), and long occlusion length (100% vs 14%) significantly differed between the groups (P ≤ .01). ConclusionsIn acute BAO, underlying ICAS does not affect optimal recanalization rate or clinical outcome. Preprocedural CT angiography is a potentially useful tool to detect it.

Computed Tomography Angiography findings can predict massive bleeding in head and neck tumours

PurposeThe aim of our study was to assess CT angiography findings of head and neck tumours in predicting carotid blow out syndrome (CBS). MethodWe retrospectively reviewed the records of patients with head and neck cancer who underwent invasive angiography for CBS at our Institution from July 2013–2019. All routine CT angiography scans were assessed for the following findings with a univariate logistic regression analysis: 1) 360 ° involvement of the suspect artery by the tumour; 2) tissue or tumour necrosis, which was defined as an hypodense area with lack of contrast enhancement in the soft tissues of the neck or tumour mass, adjacent to the suspected vessel; 3) calibre reduction of the culprit artery; 5) jugular vein infiltration. T stage was also included in the analysis. ResultsA total of 24 patients who underwent routine CT angiogram neck and embolization for CBS were included in this study. Univariate logistic regression showed as 360 ° involvement of target vessel may significantly increase the risk of bleeding (OR 11.6, CI: 1.4–91.5; p = 0.01), along with T stage (OR 14.0, p = 0.03). Tumour necrosis and calibre vessel reduction were quite influential, but not significantly (i.e. tumour necrosis OR 5.0 95 % CI: 0.8–31.0, p = 0.08). Contingency table analysis found 360 ° vessel involvement with the highest sensitivity and PPV in predicting bleeding (87.5 % and 82.35 %, respectively). ConclusionsCT angiography imaging findings have the potential to identify patients with head and neck cancer at higher risk of bleeding.

Computed tomography-based surgical strategy for total anomalous pulmonary venous connection.

We used computed tomographic angiography (CTA)-based surgical planning to clarify the anatomical indications of sutureless repair technique for total anomalous pulmonary venous connection. The mid-term impact of the current surgical strategies was evaluated. One hundred twelve patients underwent repair for total anomalous pulmonary venous connection. The study period was divided into era 1 (1996-2010, n = 56) and era 2 (2011-2018, n = 56). Patients with single ventricular heart (SVH) were included. In era 2, the indications for primary sutureless repair and branch pulmonary vein incision were based on CTA findings. For patients with biventricular heart, the 5-year survival was 69% and 97% in eras 1 and 2, respectively (P = 0.0024). For patients with SVH, the 5-year survival was 21% and 70% in eras 1 and 2, respectively (P = 0.0007). During the follow-up period, the evidence of post-repair pulmonary vein stenosis (PVS) was observed in 12 patients with biventricular heart [era 1, 8 patients (23%); era 2, 4 patients (13%)], and 14 patients with SVH [era 1, 6 patients (60%); era 2, 8 patients (36%)]. Using multivariable analysis, preoperative CTA was associated with improved survival in both biventricular heart and SVH and associated with post-repair PVS-free survival in SVH. Since 2011, 12 patients with post-repair PVS underwent multiple reintervention with 1 recorded death (5-year survival: 88%). CTA-based surgical strategy for total anomalous pulmonary venous connection provided significant survival benefit. Although post-repair PVS could occur in era 2, aggressive reintervention appeared to be associated with improved survival and vein patency.

Portable Color-Flow Ultrasound Facilitates Precision Flap Planning and Perforator Selection in Reconstructive Plastic Surgery.

Precise flap planning and perforator selection are paramount for successful perforator flap surgery. Portable color-flow ultrasound (PCFU) is a convenient, low-cost, easily accessible imaging modality that is pivotal in the planning of perforator flaps where anatomic variability is the rule. Perforator mapping was performed using an L12-4 linear-array ultrasound probe connected to an Android tablet. Images were obtained with the Lumify app (Philips Lumify, usa.philips.com). Perforator characteristics were recorded (arterial diameter, emergence points from fascia, subcutaneous course, and projection onto the skin surface) using still images and real-time videos. Thirty consecutive patients had 40 perforator or musculocutaneous flap reconstructions over a 2-year period. For the 15 flaps that had preoperative computed tomographic angiography (CTA) imaging, the preoperative sonographic measurements correlated with CTA and intraoperative findings. Portable color-flow ultrasound allowed perforator flap design and selection based on the largest available perforator, the most appropriate flap thickness, and comparison of multiple donor sites including left versus right. Two deep inferior epigastric perforator patients required take-back to the operating room for debridement of devitalized nonflap tissue. The superior gluteal artery perforator flap was abandoned intraoperatively due to proximal vascular anomalies. Overall flap success rate was 98% (39/40 flaps). Our experience with PCFU has rapidly improved, allowing individualized perforator flap selection and design based on each patient's unique perforator anatomy, reconstructive requirements, and donor site characteristics. In our practice, PCFU has supplemented CTA and in many cases has supplanted CTA as the primary imaging modality of choice in the planning of perforator flap reconstruction.

Abstract TP444: New Ischemic Lesions on Brain MRI in Patients With Blunt Traumatic Cerebrovascular Injury

Introduction: Patients admitted after high energy blunt trauma with extracranial cerebrovascular injuries on screening neck computed tomography angiography (CTA) represent a unique group of patients at risk of thromboembolic stroke. These arterial dissections account for &gt;1,000 ischemic strokes in the United States per year. Although stroke prophylaxis with antithrombotics is widely used in this setting, the risk of ischemic brain injury is unknown. Methods: This prospective observational study included 20 adult blunt trauma patients admitted with a screening CTA showing extracranial carotid or vertebral artery injury. All subjects had no initial clinical evidence of ischemic stroke, were managed with antiplatelets and observation and had brain magnetic resonance imaging (MRI) within 14 days of admission. The MRIs included diffusion, susceptibility, and FLAIR sequences to distinguish acute ischemic lesions from contusions and chronic infarctions and were read by two neuroradiologists blind to the findings of the neck CTA. A negative binomial regression adjusted for age and Injury Severity Score (ISS) was used to assess association between artery injury and lesion counts. Results: There were 12 carotid injuries and 11 unilateral or bilateral vertebral artery injuries. Mean interval between injury and MRI scan was 6.9 days. New ischemic lesions in the territory of the affected artery were present in 10 (43%) of the injured artery territories. The mean number of ischemic lesions was 7.8 (range 2-25), which was higher for territories with artery injury (mean=3.17) than those without injury (mean=0.14). None of the lesions were symptomatic. Adjusted for age and ISS, those with artery injury had a 23-fold higher average count of lesions (p=0.0004). In a sensitivity analysis excluding lesion counts &gt;1.5 standard deviation units, the association remained 11-fold higher count for artery injury (p=0.0107). Conclusions: In blunt trauma patients with CTA evidence of extracranial cerebrovascular injury and treated with antiplatelets, &gt;40% of arterial injuries are associated with ischemic lesions on MRI. Ischemic lesions on MRI may be a useful endpoint for future clinical trials of antithrombotic strategies in patients with blunt cerebrovascular injury.

Computed tomography angiography findings predict the risk factors for preoperative acute ischaemic stroke in patients with acute type A aortic dissection.

Acute ischaemic stroke (AIS) is a highly dreaded complication of acute type A aortic dissection (ATAAD). Knowledge about independent predictors of preoperative AIS in patients with ATAAD remains unclear. The aim of this study was to identify the risk factors for preoperative AIS in patients with ATAAD by computed tomography angiography (CTA) findings. Between October 2014 and March 2017, 281 (217 male; mean age, 50 years) patients with ATAAD underwent aortic CTA and diffusion-weighted magnetic resonance imaging of the brain was used to confirm the results. The clinical data and CTA findings were evaluated retrospectively. Patients were divided into 2 groups depending on the presence or absence of preoperative AIS. Preoperative AIS was detected in 103 (36.7%) of the patients with ATAAD. Univariable analysis of the clinical characteristics and CTA findings revealed that age, aortic valve insufficiency (moderate or severe), the ratio of the diameter of the true lumen of the ascending aorta to the diameter of the involved ascending aorta, intimal flap plaque, dissection of the common carotid artery (CCA), the lower density of the unilateral internal carotid artery, the CCA originating from the false lumen and dissection of the subclavian artery were implicated in patients with ATAAD with AIS. Multivariable analysis further showed that aortic valve insufficiency (moderate or severe) [odds ratio (OR) 2.033, 95% confidence interval (CI) 1.052-3.931; P = 0.035], 2 CTA findings including the ratio of the diameters (OR 0.074, 95% CI 0.011-0.516; P = 0.009) and dissection of the CCA (OR 2.422, 95% CI 1.389-4.224; P = 0.002) were independent risk predictors for preoperative AIS in patients with ATAAD. The lower density in the false lumen, the same enhancement in the true and false lumen with re-entry and the stenosis of the true lumen without re-entry significantly increased the risk of preoperative AIS in CCA dissection. Aortic valve insufficiency (moderate or severe), the ratio of the diameters of the true and false lumens and CCA dissection are independent predictors of preoperative AIS in patients with ATAAD. The specific carotid and aortic CTA findings may help to predict the risk factors for preoperative AIS in patients with ATAAD. 20120216-4.

Comparison of Computed Tomography Angiography (CTA) Findings in Post-Endovascular Aortic Aneurysm Repair CTA between Persistent and Transient Type II Endoleak

Objective: To compare first post-endovascular aortic aneurysm repair (EVAR) computed tomography angiography (CTA) imaging characteristics between transient and persistent type II endoleaks. Methods: This retrospective study enrolled patients who underwent EVAR and were diagnosed with type II endoleak from first post-operative CTA during January 2005 to October 2017 at the Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Aneurysmal sac size, aneurysmal sac growth, and endoleak were recorded among patients whose endoleak disappeared within 6 months (transient group), and among patients whose endoleak persisted for more than 6 months (persistent group). Results: Eighty-eight patients with a mean age of 75.3±7.3 years were included. Of those, 12 and 76 patients were in the transient group and persistent group, respectively. There were 71 males and 17 females. Univariate analysis showed number of feeding arteries (odds ratio [OR]: 9.9, p =0.012) and presence of inferior mesenteric artery (IMA) as an endoleak source (OR: 4.3, p =0.026) to be found more frequently in the persistent group than in the transient group; however, neither factor survived multivariate analysis. No significant difference between two groups was seen for endoleak diameter, endoleak complexity, or aneurysmal sac enlargement. Conclusion: The number of feeder arteries and presence of IMA as an endoleak source on first postoperative CTA to be more likely found in patients with persistent type II endoleak. Further prospective study in a larger study population is necessary to identify any existing statistically significant differences and/or associations.

Coronary computed tomography angiography findings in low-risk population with family history of coronary disease

A family history of early-onset CAD may promote enhanced development and progression of coronary atherosclerosis in a sibling population. Baseline algorithms may underestimate the risk of coronary incidents in susceptible individuals. CCTA provides a high diagnostic performance for the detection of atherosclerosis. However, there is a paucity of data concerning the prognostic value of this technology in relatives at familial risk of CAD. To assess CV risk and pre-test probability of CAD in patients with atypical symptoms from high-risk families. To describe CCTA findings and data on coronary angiograms. Fifty siblings of patients with premature (< 60 yrs) cardiac events were investigated. The CAD consortium was calculated (clinical model). Risk algorithms were compared (SCORE, FRS for hard coronary disease, PROCAM). Significant CAD was defined as ≥ 50% reduction in coronary luminal diameter. Pre-test probability of CAD was low: CAD consortium < 10% in 60%, SCORE < 5% in 100%, FRS < 10% in 88%, CAC scoring < 100% in 71%. Conversely, PROCAM was > 10% in 16 cases (32%). Only 12 patients (24%) presented normal CCTA. Angiography was performed in 31 cases (62%). Most patients presented no significant lesions (55%). Revascularization was performed in 8 patients (16%). In patients with abnormal CCTA findings ( n = 38), PROCAM was higher than FRS in 20 patients (53%). After investigation, lipid-lowering therapy was enhanced in 66% ( Table 1 , Fig. 1 ). We investigated patients with family history and low pre-test probability of CAD. The reclassification of cardiac risk in middle-aged adults at familial risk is a fundamental issue in preventive cardiology. Most patients presented coronary atherosclerosis on CCTA. PROCAM is more appropriate. CCTA may become useful for the screening of subclinical atherosclerosis and the prediction of coronary risk, leading to the institution of appropriate and targeted preventive measures in patients at familial risk.

Application of transesophageal echocardiography, left atrial appendage angiography, cardiac computed tomography angiography, and three-dimensional reconstruction model in left atrial appendage occlusion

Objective: The objective was to evaluate the application of transesophageal echocardiography, left atrial appendage angiography, cardiac computed tomography angiography, and three-dimensional reconstruction model in the left atrial appendage occlusion. Methods: A total of 53 patients with persistent atrial fibrillation hospitalized from January 2015 to February 2019 were selected. Transesophageal echocardiography and cardiac computed tomography angiography were performed simultaneously before operation, and three-dimensional reconstruction of the left atrial appendage model was performed based on the cardiac computed tomography angiography findings. The morphology and size of the left atrial appendage were displayed by the left atrial appendage angiography during the operation. Results: Cardiac computed tomography angiography revealed filling defects in the left atrial appendage in four patients, whereas transesophageal echocardiography revealed thrombosis in two patients of the four patients. According to the cardiac computed tomography angiography results, the morphology of the left atrial appendage was classified into chicken wing–like, cauliflower-like, wind vane–like, and cactus-like. The diameters and depths of the left atrial appendage measured by cardiac computed tomography angiography and three-dimensional reconstruction model were found to be the greatest, and the orifice sizes and depths of the left atrial appendage measured by the left atrial appendage angiography were the smallest. Conclusion: Transesophageal echocardiography, left atrial appendage angiography, cardiac computed tomography angiography, and three-dimensional reconstruction model can evaluate the morphology and size of the left atrial appendage. The cardiac computed tomography angiography and three-dimensional reconstruction model could demonstrate the internal structure of the left atrial appendage more clearly.

Computed tomography angiography findings of abdominal aortic disease: A review of emergencies

Introduction. The aorta is a major blood vessel that supplies all segments of the human body. Acute aortic syndrome is a term that implies a life-threatening aortic disease. Due to the speed of examination and widespread availability, computed tomography angiography is a front-line diagnostic modality for emergencies and diseases of the abdominal aorta. The aim of this study was to provide a wide range of potentially life-threatening abnormalities of the abdominal aorta in daily clinical and radiological practice through a series of computed tomography angiography images and three-dimensional virtual reconstruction. Abdominal aortic aneurysm is defined as a 50% increase in diameter more than the normal arterial diameter. One of the most important complications of an aneurysm is a rupture that can be acute or chronic, presenting with various clinical manifestations. Aortic dissections are caused by abnormality of the tunica media layer, forming an intimal-medial flap and two types of lumen. A penetrating aortic ulcer may erode through the internal elastic lamina of the aortic wall and allow formation of hematoma within the tunica media. Occlusive disease of the abdominal aorta may refer to the late stage of chronic aortoiliac occlusive disease, whereas the acute and/or subacute form occurs due to sudden thrombosis or occlusion. Conclusion. The recognition of specific radiological signs of abdominal aortic disease using computed tomography angiography contributes to optimal treatment of patients and reduces mortality.