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Lu G, Su Y, Jiang Y, Yang L, Wang Y, Shi G, Zhang F, Duan X, Hu H. Improving the visualisation of perforator arteries for anterolateral thigh flaps harvest in CT angiography via sublingual glyceryl trinitrate. Clin Radiol 2023; 78:e791-e797. [PMID: 37574403 DOI: 10.1016/j.crad.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 08/15/2023]
Abstract
AIM To investigate the improvement of image quality and visualisation of the anterolateral thigh (ALT) flap perforators on computed tomography angiography (CTA) after administration of sublingual glyceryl trinitrate (GTN). MATERIALS AND METHODS Sixty patients with oral lesions received thigh CTA examinations were divided randomly into two groups after administration of sublingual GTN (GTN group) or without administration of sublingual GTN (non-GTN group). Two radiologists calculated the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and assessed the image quality of each vessel. Besides, the grade of thigh artery, the lumen diameter of deep femoral artery, lateral circumflex femoral artery (LCFA), the descending branch of LCFA and its proximal and distal perforators, and the number and type of visible perforators were evaluated quantitatively. RESULTS The SNR and CNR were not significantly different between the two groups (p>0.05). The image quality of CTA in the GTN group was significantly better than that in the non-GTN group (p<0.01). The lumen diameters of the deep femoral artery, LCFA, the descending branch of LCFA and its perforators were significantly larger in the GTN group than those in the non-GTN group (p<0.01). Compared with the non-GTN group, the number of visible perforators and the number of visible septocutaneous perforators were significantly more in the GTN group, and the qualitative grade of visible perforators was significantly higher (p<0.001). CONCLUSIONS The administration of sublingual GTN in preoperative thigh CTA can improve the image quality and visualisation of perforator vessels, thus could help surgeons to select the optimum ALT flaps.
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Affiliation(s)
- G Lu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - Y Su
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - Y Jiang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - L Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - Y Wang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - G Shi
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - F Zhang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - X Duan
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - H Hu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China.
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D’Errico F, Ricci F, Luciano A, Sbordone FP, Laudazi M, Mecchia D, Volpe M, Briganti F, Di Landro A, Muscoli S, Pugliese L, De Stasio V, Di Donna C, Romeo F, Garaci F, Floris R, Chiocchi M. The Impact of Nitroglycerin on the Evaluation of Coronary Stenosis in Coronary-CT: Preliminary Study in 131 Patients. J Clin Med 2023; 12:5296. [PMID: 37629336 PMCID: PMC10455480 DOI: 10.3390/jcm12165296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The sublingual administration of short-acting nitroglycerin (NTG) before coronary computed tomography (CCT) improves the visualization of coronary arteries, causing vasodilatation. The aim of this study was to evaluate whether and how nitroglycerin can influence the concordance between radiologists and cardiologists in the evaluation of vessel stenosis measured in CCT by the former and during the following coronarography by the latter. METHODS We conducted a retrospective analysis of 131 patients who underwent CCT for cardiac symptoms in 2022, followed by coronarography performed six months later because of significant stenosis revealed by the CCT. First, the patients were divided into two groups: an NTG group who received sublingual nitroglycerin before CCT and a non-NTG group who did not because of contraindications. Second, 254 stenoses were measured by two radiologists after CCT and by two interventional cardiologists during the next coronarography; moreover, stenoses were classified on the basis of their location and plaque pattern (calcific, mixed and lipidic). Third, the strength of agreement was evaluated between the two radiologists, between the two cardiologists and finally between the radiologists and cardiologists in order to evaluate whether and how the interdisciplinary discrepancy in stenosis evaluation could change with or without the use of nitroglycerin before CCT and in relation to the different plaque pattern. RESULTS In the NTG group, the use of nitroglycerine reduced the agreement between radiologists and cardiologists in calcific stenosis but did not change the concordance in the case of mixed or lipidic plaques on the same vessels. CONCLUSIONS The use of sublingual nitroglycerin before CCT may lead to a radiological overestimation of calcific stenosis.
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Affiliation(s)
- Francesca D’Errico
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Francesca Ricci
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Alessandra Luciano
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Francesco Paolo Sbordone
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Mario Laudazi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Daniele Mecchia
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Maria Volpe
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Flavia Briganti
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Alessio Di Landro
- Unit of Cardiology and Interventional Cardiology, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (A.D.L.); (S.M.)
| | - Saverio Muscoli
- Unit of Cardiology and Interventional Cardiology, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (A.D.L.); (S.M.)
| | - Luca Pugliese
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Vincenzo De Stasio
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Carlo Di Donna
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Francesco Romeo
- Faculty of Medicine, UniCamillus International Medical University, 00131 Rome, Italy;
| | - Francesco Garaci
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Roberto Floris
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Marcello Chiocchi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
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Yang L, Yan Z, Lu G, Jiang Y, Wang Y, Shi G, Chen L, Hu H, Duan X. Nitroglycerin improves the visibility of fibula-free flap perforators on computed tomography angiography in patients with oral or maxillofacial lesion. Eur J Radiol 2023; 164:110877. [PMID: 37187079 DOI: 10.1016/j.ejrad.2023.110877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/30/2023] [Accepted: 05/05/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE To investigate the improvement of image quality and visualization of fibula-free flap (FFF) perforators on computed tomography angiography (CTA) after administration of sublingual nitroglycerin (NTG) tablets. METHODS A total of 60 patients with oral or maxillofacial lesions before CTA of the lower extremity were randomly divided into two groups (NTG group and non-NTG group). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), overall image quality and grading of vessels were evaluated and compared. The lumen diameters of the major arteries and the proximal and distal peroneal perforators were measured. The number of visible perforators in muscular clearance and muscular layer was also counted and compared between the two groups. RESULTS The CNR of posterior tibial artery and overall image quality of CTA images in the NTG group was significantly higher than that in the non-NTG group (p < 0.05), although the SNR and CNR of other arteries did not show significant differences (p > 0.05). The lumen diameters of the peroneal artery and its perforators, anterior tibial artery, and posterior tibial artery were significantly larger in the NTG group (p < 0.001), while no significant difference prevailed in the diameter of the popliteal artery between the two groups (p = 0.298). Compared with the non-NTG group, a significant increase in the number of visible perforators was noted in the NTG group (p < 0.001). CONCLUSIONS The administration of sublingual NTG in CTA of the lower extremity can improve the image quality and visualization of perforators, which aids to surgeons select the optimum FFF.
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Affiliation(s)
- Lingjie Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Zhuoheng Yan
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Guoxiong Lu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Yusong Jiang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Yu Wang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Guangzi Shi
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Lina Chen
- CHN DI CT Collaboration, Siemens Healthcare Ltd, No.399 West Haiyang Road, Shanghai 200126, China
| | - Huijun Hu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China
| | - Xiaohui Duan
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou 510120, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
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Nitrates administered by spray versus tablet: comparison of coronary vasodilation on CT angiography. Eur Radiol 2020; 31:515-524. [PMID: 32785771 DOI: 10.1007/s00330-020-07104-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/04/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare the coronary vasodilation effects of spray with those induced by tablet administration in coronary CT angiography (CCTA). METHODS A total of 2024 patients who underwent CCTA were identified for this retrospective study, including 828 patients with spray (spray group) and 1169 with tablets (tablet group). Of these, 93 patients underwent CCTA at least twice using both spray and tablets. The number of measurable segments and diameters of all 18 segments was measured. The number of measurable segments was compared between groups. RESULTS No statistically significant differences were evident between these two groups in terms of clinical characteristics. All coronary segments except the ramus intermedius (RI) and left posterior descending artery (L-PDA) were significantly larger in the spray group than in the tablet group (all p < 0.001). In peripheral and branch vessels, as well as in central and main coronary arteries, the diameters were significantly larger in the spray group than in the tablet group (all p < 0.001). Although not always statistically significant, all coronary segments tended to be more measurable on CCTA with spray than with tablet. In the subgroup that underwent CCTA twice using both spray and tablets, all coronary segments except the RI, obtuse marginal artery 2 (OM2), and L-PDA were significantly larger in the spray group than in the tablet group (all p < 0.05). CONCLUSION Lingual isosorbide dinitrate (ISDN) spray was more efficacious than sublingual nitroglycerin (NTG) tablets in coronary vasodilation for CCTA. Therefore, lingual ISDN spray should be preferred over sublingual NTG tablets for CCTA. KEY POINTS • Lingual ISDN spray was more efficacious than sublingual NTG tablet for coronary vasodilation in coronary CT angiography, even in elderly patients. • The diameters of all coronary segments except RI and L-PDA were significantly larger, and there were significantly more coronary segments greater than 1.5 mm, except RI and L-PDA, in the spray group than in the tablet group in the whole study group. • Even in peripheral and branch vessels, the diameters of coronary arteries were significantly larger in the spray group than in the tablet group, and they were also larger in elderly patients.
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