Background: CTA has replaced angiography in both diagnosis and evaluation of aortic dissection. Most findings are associated with true and false lumens which account for the most important information in both diagnosis and management.
Objective: To describe computed tomographic (CT) findings including types based on Stanford classification, true and false lumens, acute and chronic aortic dissections, relation to origins of aortic branches, complications and other related findings.
Methods: Computed tomographic angiography (CTA) scans of one hundred and twenty patients with aortic dissection during 2007 to 2016 were retrospectively reviewed. The findings indicating types, true and false lumens, acute and chronic, origination of aortic branches, complication and other related findings are categorized.
Result: Most true lumens were smaller, having outer wall calcification. Most false lumens were larger, showing beak sign, cobweb sign, and intraluminal thrombi. However, the larger lumens could be true lumens as well as the smaller lumen could be a false lumen and outer wall calcification could be seen in a false lumen. The larger true lumens and the smaller false lumens with outer wall calcifications were more often found in chronic aortic dissection than acute aortic dissection. Both acute and chronic aortic dissections were more Stanford type B than type A. Complications included rupture, hemopericardium, hemothorax, hemomediastinum and distal organ infarction, which were more frequent in acute dissection. Intrathoracic complications were more commonly caused by type A acute dissection. Renal infarction was the most common complication in type B acute aortic dissection.
Conclusion: Most CT fi ndings of aortic dissection in this study were typical. Atypical fi ndings were also found in both acute and chronic aortic dissections. Outer wall calcifi cations of false lumens in acute aortic dissection were found in 2 cases.
To evaluate the ability of thoraco-abdominal MDCT angiography to visualize Adamkiewicz arteries for preoperative planning in patients diagnosed with aortic disease.The present study retrospectively reviewed clinical data from 73 patients who underwent a thoraco-abdominal 64-slice MDCT angiography. The Adamkiewicz artery was evaluated on multiplanar reformation images in each case. The visualization of the Adamkiewicz artery, level of origin, side of origin and continuation from an intercostal artery was investigated.The Adamkiewicz arteries were visualized in 52 of the 73 patients (71.2%), and the total number of the delineated Adamkiewicz arteries was 64. Two Adamkiewicz arteries were found in nine patients (17.3%). Four Adamkiewicz arteries were found in one patient (1.9%). Most of the delineated arteries arose from the T9-L2 levels (89.1%). A left side of origin was found in 41 of 64 arteries (64.1%), and a right side of origin was found in 23 of 64 arteries (35.9%). Only 12 of 64 delineated arteries (18.8%) showed continuity from their origins to the anterior radiculomedullary artery.The preoperative detection rate of the Adamkiewicz artery with the routine technique of 64-slice MDCT angiography was 71.2%. The preoperative location of the Adamkiewicz artery may help to reduce the risk of perioperative ischemic changes in the spinal cord.
Coronary heart disease requires advanced investigations. However, findings of fundamental investigations are sometimes underused and/or neglected, such as plain chest X-ray (CXR) and electrocardiography (ECG). A previous study found an association between aortic calcification and coronary artery disease, but there are no studies that have investigated association between aortic arch calcification in CXR and coronary artery disease consequences, such as myocardial viability (scarring).To investigated association between aortic arch calcification detected on plain CXR and myocardial scarring detected on cardiac magnetic resonance imaging (CMRI) in coronary heart disease patients.one hundred eighty-seven eligible patients aged ≥18 years and diagnosed as coronary heart disease by CMRI at Siriraj Hospital between January 2008 and December 2014 study periods were enrolled. We retrospectively reviewed aortic arch calcification from plain CXR, demographic data, hospitalization data, underlying disease, medications used, and CMRI parameters.There was no significant association between aortic arch calcification from CXR and myocardial scar by CMRI. Aortic arch calcification was detected in 86 (45.98%) and 78 (41.70%) of patients with and without myocardial scar by CMRI (p = 0.981). There was no significant correlation between calcium grading and calcium thickness from CXR and the presence or absence of myocardial scar by CMRI. Myocardial scar was detected in 52.2%, 47.8%, 51.4%, and 59.1% in patients with calcium grade 0, 1, 2, and 3 respectively (p = 0.751).There was no association found between aortic arch calcification detected on plain CXR and myocardial scarring detected on CMRI.
Background: CT is a well-known tool to assess several conditions in living patients. The post-mortem CT (PMCT) has been introduced to determine the cause of death in dead subjects. CT is also the imaging modality of choice for the analysis of autopsy findings including fracture, hematoma, gas collection and gross tumor injury. The rate of standard autopsy is continuing to decline and there are several reasons for refusing autopsy. Objective: The current research endeavor is investigate the usefulness of computed tomography (CT) in cases refusing autopsy. Materials and Methods: In this study, the PMCT were evaluated in 150 subjects in different contexts of death. The causes of death were classified into four categories which include a definite cause of death, a possible cause of death, a minor pathological finding and no fatal findings. For the definite cause of death and the possible cause of death, the specific lesions are described in detail. Results: The definite cause of death was detected in 48 (32%) of the subjects. The possible cause of death was detected in 18 (12%) of the subjects. The remaining 84 subjects were classified into minor pathological findings and no fatal findings in 46 (30.7%) and 38 (25.3%) of the patients, respectively. The fatal lesions of PMCT were found in 93 lesions(48 subjects) that were demonstrated by anatomical locations into the traumatic bone, intracranial, spine, thoracic, heart leak and abdominal lesions. We found definite causes of death in 6 subjects, which had no history of trauma and malignancy and were mentioned about a cardiopulmonary failure as a cause of death at first. Conclusion: The PMCT is a useful tool for identifying the cause of death in many cases that have limitations for conventional autopsy. The morphological change such as intracranial hemorrhage is easily diagnosed with PMCT. The PMCT appears to be an alternative tool to assess the cause of death in any reason of objections.
A retrospective study was undertaken to evaluate the appearance of the aortic wall on computed tomography for the purpose of developing criteria for differentiating acute aortic intramural hematoma from thrombosed false lumen seen in aortic dissection. Computed tomography angiography findings of the thoracoabdominal aorta in 23 patients with suspected intramural hematoma and 25 with thrombosed false lumen were reviewed. The more common features of an intramural hematoma were hyperattenuation of the aortic wall, wall thickness less than a quarter of the aortic diameter, intrinsic wall calcification, a lesion extending around the entire aortic circumference, and ulcer-like projections that may be precursors of intramural hematoma. Wall thickness less than a quarter of the aortic diameter, lesion extending around the entire aortic circumference, and ulcer-like projections were the most useful indicators for distinguishing intramural hematoma from the thrombosed false lumen in aortic dissection.
Background: CTA has replaced angiography in both diagnosis and evaluation of aortic dissection. Most findings are associated with true and false lumens which account for the most important information in both diagnosis and management. Objective: To describe computed tomographic (CT) findings including types based on Stanford classification, true and false lumens, acute and chronic aortic dissections, relation to origins of aortic branches, complications and other related findings. Methods: Computed tomographic angiography (CTA) scans of one hundred and twenty patients with aortic dissection during 2007 to 2016 were retrospectively reviewed. The findings indicating types, true and false lumens, acute and chronic, origination of aortic branches, complication and other related findings are categorized. Result: Most true lumens were smaller, having outer wall calcification. Most false lumens were larger, showing beak sign, cobweb sign, and intraluminal thrombi. However, the larger lumens could be true lumens as well as the smaller lumen could be a false lumen and outer wall calcification could be seen in a false lumen. The larger true lumens and the smaller false lumens with outer wall calcifications were more often found in chronic aortic dissection than acute aortic dissection. Both acute and chronic aortic dissections were more Stanford type B than type A. Complications included rupture, hemopericardium, hemothorax, hemomediastinum and distal organ infarction, which were more frequent in acute dissection. Intrathoracic complications were more commonly caused by type A acute dissection. Renal infarction was the most common complication in type B acute aortic dissection. Conclusion: Most CT fi ndings of aortic dissection in this study were typical. Atypical fi ndings were also found in both acute and chronic aortic dissections. Outer wall calcifi cations of false lumens in acute aortic dissection were found in 2 cases.
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.
Background: An accurate estimation of pericardial fluid volume could improve communication between radiologists and the multidisciplinary team. Objective: To find the correlation between the volume and thickness of pericardial effusion measured by CT scan. Materials and Methods: The chest CT scans of 38 patients with pericardial effusion were measured for volume using manual segmentation and for thickness on axial and 3-chamber planes from the anterior and posterior aspects. The correlation between volume and thickness was evaluated using Pearson’s correlation coefficient (r). The reliability of the measurements was tested using intraclass correlation coefficient (ICC) and Bland-Altman analysis. Results: There was a fair to moderately strong correlation between the volume and thickness of pericardial effusion (r= 0.435-0.625, p= <0.01). An ICC of 0.452-0.703 indicated moderate inter-observer agreement. The best measurement is the sum of the anterior and posterior thicknesses on the axial plane (ICC of 0.703) that correlates well with the volume (r= 0.624). A linear regression equation demonstrating the relationship between pericardial effusion thickness and the effusion volume was computed as; Volume (mL) = 73 + 71*(the sum of anterior and posterior thicknesses on axial view in cm). The equation was applied: a value of approximately 3 cm = small, 6 cm = moderate, and 9 cm = large pericardial effusion. Conclusion: There is a moderate correlation between the sum of the anterior and posterior pericardial thicknesses and the pericardial volume. Our preliminary formula enables a rapid estimation of the effusion volume. Further validation and refinement of the formula in a larger, prospective study is needed.
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