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Lin J, Chen S, Yao Y, Yan M. Status of diagnosis and therapy of abdominal aortic aneurysms. Front Cardiovasc Med 2023; 10:1199804. [PMID: 37576107 PMCID: PMC10416641 DOI: 10.3389/fcvm.2023.1199804] [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: 04/04/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Abdominal aortic aneurysms (AAAs) are characterized by localized dilation of the abdominal aorta. They are associated with several serious consequences, including compression of adjacent abdominal organs, pain, treatment-related financial expenditure. The main complication of AAA is aortic rupture, which is responsible for about 200,000 deaths per year worldwide. An increasing number of researchers are dedicating their efforts to study AAA, resulting in significant progress in this field. Despite the commendable progress made thus far, there remains a lack of established methods to effectively decelerate the dilation of aneurysms. Therefore, further studies are imperative to expand our understanding and enhance our knowledge concerning AAAs. Although numerous factors are known to be associated with the occurrence and progression of AAA, the exact pathway of development remains unclear. While asymptomatic at most times, AAA features a highly unpredictable disease course, which could culminate in the highly deadly rupture of the aneurysmal aorta. Current guidelines recommend watchful waiting and lifestyle adjustment for smaller, slow-growing aneurysms, while elective/prophylactic surgical repairs including open repair and endovascular aneurysm repair are recommended for larger aneurysms that have grown beyond certain thresholds (55 mm for males and 50 mm for females). The latter is a minimally invasive procedure and is widely believed to be suited for patients with a poor general condition. However, several concerns have recently been raised regarding the postoperative complications and possible loss of associated survival benefits on it. In this review, we aimed to highlight the current status of diagnosis and treatment of AAA by an in-depth analysis of the findings from literatures.
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Affiliation(s)
- Jinping Lin
- Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuwei Chen
- Department of anesthesiology, The First People's Hospital of Fuyang, Hangzhou, China
| | - Yuanyuan Yao
- Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Min Yan
- Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Basha MAA, Salem AF, Azmy TM, Shehata SM. The added value of CT virtual angioscopy to MDCT angiography in the evaluation of aortic diseases. Abdom Radiol (NY) 2020; 45:2576-2584. [PMID: 32564211 DOI: 10.1007/s00261-020-02607-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Incorporation of virtual angioscopy (VA) in the diagnostic work-up of aortic diseases could improve the clinical value and efficiency of multidetector computed tomography angiography (MDCTA). We aim to evaluate the clinical usefulness of virtual aortic navigation by CT angiography in various aortic diseases as a complement to standard MDCTA. MATERIALS AND METHODS We retrospectively selected 211 patients who performed MDCTA for suspected or operated aortic diseases. VA endoluminal images of the aorta were obtained by a fly-through technique. Two senior vascular radiologists independently evaluated all MDCTA images. After 1 month, the same two radiologists independently reviewed the MDCTA images combined with CTVA images. The respective accuracy of CTVA in delineating aortic abnormalities was compared to that of MDCTA using Fisher's exact test. The Fleiss kappa (κ) statistic was used to assess the inter-reader agreement (IRA). RESULTS We detected 229 abnormalities in 203 patients on MDCTA and 231 abnormalities in 205 patients on CTVA. CTVA provided significant additional findings in 63.8% (146/229) of all abnormalities diagnosed by MDCTA (p < 0.001, odd ratio [OR] = 42). Although CTVA diagnosed two abnormalities overlooked by MDCTA, the value was statistically insignificant (p = 0.787, OR = 1.3). Regarding postoperative abnormalities, the CTVA added significant additional findings over MDCTA (p = 0.006, OR = 87.4). The overall IRA for the performance of CTVA was good (κ = 0.699). CONCLUSIONS CTVA yields extra findings and improves diagnostic efficiency of MDCTA, especially in postoperative patients.
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Kumar Y, Hooda K, Li S, Goyal P, Gupta N, Adeb M. Abdominal aortic aneurysm: pictorial review of common appearances and complications. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:256. [PMID: 28706924 DOI: 10.21037/atm.2017.04.32] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abdominal aortic aneurysms (AAAs) are defined as focal dilatations of the abdominal aorta that are 50% greater than the proximal normal segment or when it is more than 3 cm in maximum diameter. The early diagnosis and treatment is very important to prevent catastrophic complications. Due to its ability to assess the peri-aortic soft tissue and the exact extension of aneurysm, as well as its excellent vascular opacification and multiplanar reconstruction capabilities, computed tomography angiography (CTA) has become an integral part of the evaluation of AAA and has virtually replaced conventional angiography for the evaluation of AAA. Knowledge of the characteristic imaging features of AAA is essential for the prompt diagnosis of life-threatening complications. In this pictorial essay, we will discuss the CTA findings in AAA and its complications including rupture, infection, aorto-enteric fistula and aorto-caval fistula.
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Affiliation(s)
- Yogesh Kumar
- Department of Radiology, Yale New Haven Health at Bridgeport Hospital, Bridgeport, CT, USA
| | - Kusum Hooda
- Department of Radiology, Yale New Haven Health at Bridgeport Hospital, Bridgeport, CT, USA
| | - Shuo Li
- Department of Radiology, Yale New Haven Health at Bridgeport Hospital, Bridgeport, CT, USA
| | - Pradeep Goyal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Nishant Gupta
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Melkamu Adeb
- Department of Radiology, Yale New Haven Health at Bridgeport Hospital, Bridgeport, CT, USA
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ACR Appropriateness Criteria ® Pulsatile Abdominal Mass Suspected Abdominal Aortic Aneurysm. J Am Coll Radiol 2017; 14:S258-S265. [DOI: 10.1016/j.jacr.2017.01.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 11/20/2022]
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Yanmaz R. ÇOK KESİTLİ BİLGİSAYARLI TOMOGRAFİ İLE PORTAL VEN ANATOMİK VARYASYONLARININ DEĞERLENDİRİLMESİ. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2017. [DOI: 10.17944/mkutfd.304243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Lahoz C, Gracia CE, García LR, Montoya SB, Hernando ÁB, Heredero ÁF, Tembra MS, Velasco MB, Guijarro C, Ruiz EB, Pintó X, de Ceniga MV, Moñux Ducajú G. [Not Available]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28 Suppl 1:1-49. [PMID: 27107212 DOI: 10.1016/s0214-9168(16)30026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Carlos Lahoz
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España.
| | - Carlos Esteban Gracia
- Servicio de Angiología y Cirugía Vascular, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | | | - Sergi Bellmunt Montoya
- Servicio de Angiología y Cirugía Vascular, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Ángel Brea Hernando
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital San Pedro, Logroño, España
| | | | - Manuel Suárez Tembra
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital San Rafael, A Coruña, España
| | - Marta Botas Velasco
- Servicio de Angiología y Cirugía Vascular, Hospital de Cabueñes, Gijón, España
| | - Carlos Guijarro
- Consulta de Riesgo Vascular, Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Esther Bravo Ruiz
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Basurto, Bilbao, España
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - Melina Vega de Ceniga
- Servicio de Angiología y Cirugía Vascular, Hospital de Galdakao-Usansolo, Vizcaya, España
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Influence of computed tomography angiography reconstruction software on anatomic measurements and endograft component selection for endovascular abdominal aortic aneurysm repair. J Vasc Surg 2014; 59:1224-31.e1-3. [DOI: 10.1016/j.jvs.2013.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/30/2013] [Accepted: 11/03/2013] [Indexed: 11/18/2022]
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François CJ. Noninvasive Imaging Workup of Patients with Vascular Disease. Surg Clin North Am 2013; 93:741-60, vii. [DOI: 10.1016/j.suc.2013.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Combining radiological imaging and gastrointestinal tonometry: a minimal invasive and useful approach for the workup of chronic gastrointestinal ischemia. Eur J Gastroenterol Hepatol 2013; 25:719-25. [PMID: 23395993 DOI: 10.1097/meg.0b013e32835ddc45] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The established approach for patients suspected of chronic gastrointestinal ischemia (CGI) includes assessment of medical history, vascular imaging, such as by digital subtraction angiography, and, more recently, computed tomography angiography (CTA) or magnetic resonance angiography. Mucosal perfusion assessment techniques have recently been shown to be of additional diagnostic value, including visible light spectroscopy and gastric exercise tonometry. Gastric exercise tonometry, however, is cumbersome and impossible to perform in a considerable proportion of patients. An alternative approach is provided by 24 h gastrointestinal tonometry (TM). We challenged the use of TM in combination with CTA as an alternative approach to evaluate patients suspected of CGI. METHODS Patients referred for suspected CGI were prospectively evaluated using CTA and TM, and discussed in a multidisciplinary team, where a consensus diagnosis was made. CGI patients were offered therapy. Persistent symptom relief after adequate therapy during follow-up was used as the 'gold standard' and was defined as a definitive diagnosis of CGI. RESULTS In 31 months, 186 patients were included (men 69, mean age 63 years). A consensus diagnosis of CGI was made in 128 (69%) patients: 94 with occlusive and 34 with nonocclusive CGI. After a median follow-up of 21 months after a therapeutical intervention, 91% of the CGI patients were free from symptoms. CONCLUSION In patients clinically suspected of CGI, the combination of CTA and TM provides a minimally invasive, reliable diagnostic approach, which seems to be very useful in clinical practice and to have an outcome similar to the established diagnostic workup.
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Ghatwary TMH, Patterson BO, Karthikesalingam A, Hinchliffe RJ, Loftus IM, Morgan R, Thompson MM, Holt PJE. A systematic review of protocols for the three-dimensional morphologic assessment of abdominal aortic aneurysms using computed tomographic angiography. Cardiovasc Intervent Radiol 2013; 36:14-24. [PMID: 22159906 DOI: 10.1007/s00270-011-0296-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 10/09/2011] [Indexed: 10/14/2022]
Abstract
The morphology of infrarenal abdominal aortic aneurysms (AAAs) directly influences the perioperative outcome and long-term durability of endovascular aneurysm repair. A variety of methods have been proposed for the characterization of AAA morphology using reconstructed three-dimensional (3D) computed tomography (CT) images. At present, there is lack of consensus as to which of these methods is most applicable to clinical practice or research. The purpose of this review was to evaluate existing protocols that used 3D CT images in the assessment of various aspects of AAA morphology. An electronic search was performed, from January 1996 to the end of October 2010, using the Embase and Medline databases. The literature review conformed to PRISMA statement standards. The literature search identified 604 articles, of which 31 studies met inclusion criteria. Only 15 of 31 studies objectively assessed reproducibility. Existing published protocols were insufficient to define a single evidence-based methodology for preoperative assessment of AAA morphology. Further development and expert consensus are required to establish a standardized and validated protocol to determine precisely how morphology relates to outcomes after endovascular aneurysm repair.
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Affiliation(s)
- Tamer M H Ghatwary
- Department of Outcomes Research, St. George's Vascular Institute, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK
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Ghatwary T, Karthikesalingam A, Patterson B, Hinchliffe R, Morgan R, Loftus I, Salem A, Thompson MM, Holt PJ. St George's Vascular Institute Protocol: An Accurate and Reproducible Methodology to Enable Comprehensive Characterization of Infrarenal Abdominal Aortic Aneurysm Morphology in Clinical and Research Applications. J Endovasc Ther 2012; 19:400-14. [DOI: 10.1583/11-3731mr.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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ACR Appropriateness Criteria® pulsatile abdominal mass, suspected abdominal aortic aneurysm. Int J Cardiovasc Imaging 2012; 29:177-83. [PMID: 22644671 PMCID: PMC3550697 DOI: 10.1007/s10554-012-0044-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 03/23/2012] [Indexed: 12/17/2022]
Abstract
Clinical palpation of a pulsating abdominal mass alerts the clinician to the presence of a possible abdominal aortic aneurysm (AAA). Generally an arterial aneurysm is defined as a localized arterial dilatation ≥50% greater than the normal diameter. Imaging studies are important in diagnosing the cause of a pulsatile abdominal mass and, if an AAA is found, in determining its size and involvement of abdominal branches. Ultrasound (US) is the initial imaging modality of choice when a pulsatile abdominal mass is present. Noncontrast computed tomography (CT) may be substituted in patients for whom US is not suitable. When aneurysms have reached the size threshold for intervention or are clinically symptomatic, contrast-enhanced multidetector CT angiography (CTA) is the best diagnostic and preintervention planning study, accurately delineating the location, size, and extent of aneurysm and the involvement of branch vessels. Magnetic resonance angiography (MRA) may be substituted if CT cannot be performed. Catheter arteriography has some utility in patients with significant contraindications to both CTA and MRA. The American College of Radiology Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Gómez Palonés F, Vaquero Puerta C, Gesto Castromil R, Serrano Hernando F, Maeso Lebrun J, Vila Coll R, Clará Velasco A, Escudero Román J, Riambau Alonso V. Tratamiento endovascular del aneurisma de aorta abdominal. ANGIOLOGIA 2011. [DOI: 10.1016/j.angio.2011.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pitoulias GA, Donas KP, Schulte S, Aslanidou EA, Papadimitriou DK. Two-dimensional versus three-dimensional CT angiography in analysis of anatomical suitability for stentgraft repair of abdominal aortic aneurysms. Acta Radiol 2011; 52:317-23. [PMID: 21498369 DOI: 10.1258/ar.2010.100229] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The morphological analysis prior to endovascular abdominal aneurysm repair (EVAR) plays an important role in long-term outcomes. Post-imaging analysis of computed tomographic angiography (CTA) by three-dimensional reconstruction with central lumen line detection (CLL 3D-CTA) enables measurements to be made in orthogonal slices. This might be more precise than equal post-imaging analysis in axial slices by two-dimensional computed tomographic angiography (2D-CTA). PURPOSE To evaluate the intra- and interobserver variability of CLL 3D-CTA and 2D-CTA post-imaging analysis methods and the agreement between them in pre-EVAR suitability analysis of patients with abdominal aortic aneurysm (AAA). MATERIAL AND METHODS Anonymized CTA data-sets from 70 patients with AAA were analyzed retrospectively. Length measurements included proximal and distal aortic neck lengths and total distance from the lower renal artery to the higher iliac bifurcation. Width measurements included proximal and distal neck diameters, maximum AAA diameter and common iliac diameters just above the iliac bifurcations. The measurements were performed in random order by two vascular surgeons, twice per method with 1-month interval between readings. In the CLL 3D-CTA method we used semi-automated CLL detection by software and manual measurements on CTA slices perpendicular to CLL. The equal measurements in 2D-CTA were performed manually on axial CTA slices using a DICOM viewer workstation. The intra- and interobserver variability, as well as the agreement between the two methods were assessed by Bland-Altman test and bivariate correlation analysis. RESULTS The intraobserver variability was significantly higher in 2D-CTA measurements for both readers. The interobserver variability was significant in 2D-CTA measurements of proximal neck dimensions while the agreement in CLL 3D-CTA analysis between the two readers was excellent in all studied parameters. The agreement between the two suitability analysis techniques was poor for both readers, especially in measurements of proximal neck's dimensions and in total aortoiliac length (p = 0.001). CONCLUSION In pre-EVAR morphological evaluation of AAAs the CLL-3D CTA post-imaging analysis has better intra- and interobserver correlation than 2D-CTA and might represent a useful tool for the proper selection of endograft's type and size.
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Affiliation(s)
- Georgios A Pitoulias
- G Gennimatas Hospital, 2nd Surgical Department – Division of Vascular Surgery, Aristotle University of Thessaloniki, Ethnikis Aminis 41, 54635, Thessaloniki, Greece
| | | | - Stefan Schulte
- Center for Vascular Medicine and Vascular Surgery, MediaPark Klinik, Cologne, Germany
| | - Eleni A Aslanidou
- G Gennimatas Hospital, 2nd Surgical Department – Division of Vascular Surgery, Aristotle University of Thessaloniki, Ethnikis Aminis 41, 54635, Thessaloniki, Greece
| | - Dimitrios K Papadimitriou
- G Gennimatas Hospital, 2nd Surgical Department – Division of Vascular Surgery, Aristotle University of Thessaloniki, Ethnikis Aminis 41, 54635, Thessaloniki, Greece
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Moussa O, Al Samaraee A, Ray R, Nice C, Bhattacharya V. A Tender Pulsatile Epigastric Mass is NOT Always an Abdominal Aortic Aneurysm: A Case Report and Review of Literature. J Radiol Case Rep 2010; 4:26-31. [PMID: 22470694 DOI: 10.3941/jrcr.v4i10.458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Of greatest concern in the assessment of a patient with a tender pulsatile abdominal mass is the possibility of a leaking or ruptured Abdominal Aortic Aneurysm (AAA). Other serious abdominal pathologies may demonstrate the same clinical signs but require entirely different treatments. Even amongst patients with proven abdominal aortic aneurysms CT imaging findings may influence the timing and nature of surgery and provide useful prognostic information. We present a case in which a large abdominal tender pulsatile mass was not aortic in origin. The patient had a significantly large tender congested liver associated with right side heart failure due to progressive tricuspid valve regurgitation. We have also discussed the differential diagnoses which may mimic abdominal aneurysms and discussed the role of imaging in resolving these problems.
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Affiliation(s)
- Osama Moussa
- Department of General and Vascular Surgery, Queen Elizabeth Hospital, Gateshead, UK
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Turba UC, Uflacker R, Bozlar U, Hagspiel KD. Normal renal arterial anatomy assessed by multidetector CT angiography: are there differences between men and women? Clin Anat 2009; 22:236-42. [PMID: 19172661 DOI: 10.1002/ca.20748] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The purpose of this study was to determine renal arterial anatomy and gender differences in adults without renovascular disease using multidetector computed tomography angiography (MDCTA). MDCTA datasets of 399 patients were retrospectively reviewed. Measurements of the aortorenal diameters, the angulation of the renal ostia and pedicles as well as the distance between the origins of the renal arteries were measured. Differences in measurements between genders were tested for statistical significance using analysis of variance (ANOVA) and Pearson's Chi-Square tests. A total of 798 renal arteries were available for analysis in 207 female (mean age = 52.91 years) and 192 male patients (mean age = 53.04 years). Female patients were found to have smaller aortae (at the level of the right renal ostium) and bilateral renal arteries than males (mean aortic diameter M/F = 18.33/15.89 mm, mean right renal artery ostial diameter M/F = 5.06/4.59 mm, mean left ostial renal diameter M/F = 5.14/4.66 mm) (p < .001). There was no statistical significance for the renal ostia level in relation to the vertebrae and the majority of renal arteries originated at the L1 and L2 levels. The longitudinal distance between right and left renal artery ostia ranged from 0 to 32 mm (mean = 4,6 mm, median = 5mm). The mean anteroposterior orientation of the right renal ostia was M/F = 29.45 degrees/28.20 degrees , and M/F = -7.96 degrees/-11.14 degrees for left renal artery ostia. The mean anteroposterior orientation of the right renal pedicle was M/F = 41.37 degrees/44.34 degrees and M/F = 42.31 degrees/43.95 degrees for the left pedicle. There are some differences in normal renal arterial anatomy between genders. Normal renal arterial information is useful not only for planning and performing of endovascular and laparoscopic urologic procedures, but also for medical device development.
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Affiliation(s)
- Ulku Cenk Turba
- Department of Radiology, University of Virginia, Health System Foundation, Charlottesville, Virginia 22908, USA.
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Centerline Analysis of Aortic CT Angiographic Examinations: Benefits and Limitations. AJR Am J Roentgenol 2009; 192:W255-63. [DOI: 10.2214/ajr.08.1488] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Higashiura W, Kichikawa K, Sakaguchi S, Tabayashi N, Taniguchi S, Uchida H. Accuracy of Centerline of Flow Measurement for Sizing of the Zenith AAA Endovascular Graft and Predictive Factor for Risk of Inadequate Sizing. Cardiovasc Intervent Radiol 2009; 32:441-8. [DOI: 10.1007/s00270-009-9531-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 01/15/2009] [Accepted: 01/27/2009] [Indexed: 11/24/2022]
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Fortuño Andrés JR, Falco i Fages J, Perendreu i Sans J, Branera i Pujol J, Bermúdez Bencerrey P, Bellmunt i Montoya S, Safont i Sala MR. [Multislice CT angiography in the study of aneurysm of the abdominal aorta: comparison of three different volumes of contrast agent]. RADIOLOGIA 2008; 50:225-30. [PMID: 18471387 DOI: 10.1016/s0033-8338(08)71968-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To prospectively and quantitatively compare the use of different volumes of contrast in 16-slice CT angiography for the study of aneurysms of the abdominal aorta before and/or after treatment. MATERIAL AND METHODS From November 2005 to March 2006, we included 63 consecutive patients referred for CT angiography for aneurysm of the abdominal aorta or for post-treatment follow-up. Each patient was randomly assigned to one of three groups: group A was administered 100 mL of contrast agent, group B 80 mL, and group C 60 mL. In all cases, contrast was administered with 40 mL of physiological serum at a rate of 4 ml/s. A 16-detector CT scanner was used. In the last 61 patients, attenuation was measured in different locations using circular ROIs. Hounsfield units were recorded in the first slice (initial contrast), in the last slice (final contrast), at their maximum value, and also at one-second intervals. RESULTS No statistically significant differences in the Hounsfield units recorded in the first slice, in the last slice, or in the maximum values were found between the different groups. Mean values were above 200 in 58 of 61 patients. Weight and body mass index (BMI) were negatively correlated with aortoiliac attenuation. CONCLUSION Using a 16-detector CT scanner enables the volume of contrast for studies of aneurysms of the abdominal aorta to be reduced considerably; however, 60 mL might not be sufficient for patients with high weight or BMI.
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Affiliation(s)
- J R Fortuño Andrés
- Unidad de Radiología Vascular e intervencionista. Corporación Sanitaria Parc Taulí. Hospital de Sabadell. Barcelona. España.
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Diehm N, Pena C, Benenati JF, Tsoukas AI, Katzen BT. Adequacy of an early arterial phase low-volume contrast protocol in 64-detector computed tomography angiography for aortoiliac aneurysms. J Vasc Surg 2008; 47:492-8. [DOI: 10.1016/j.jvs.2007.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 11/02/2007] [Accepted: 11/03/2007] [Indexed: 10/22/2022]
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Sahani DV, Kalva SP, Hahn PF, Saini S. 16-MDCT Angiography in Living Kidney Donors at Various Tube Potentials: Impact on Image Quality and Radiation Dose. AJR Am J Roentgenol 2007; 188:115-20. [PMID: 17179353 DOI: 10.2214/ajr.05.0583] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to compare the performance of 16-MDCT angiography at various peak kilovoltage (kVp) settings and the impact of the different settings on image quality and on radiation dose in adult kidney donors. MATERIALS AND METHODS Sixty-two renal donors (32 men, 30 women) who underwent 16-MDCT were divided into three groups: 18 subjects were studied at 140 kVp (group A); 20, at 120 kVp (group B); and 24, at 100 kVp (group C). Other constant scanning parameters were as follows: detector collimation, 0.625 mm; table feed, 9.375 mm/rotation; gantry rotation time, 500 milliseconds; and automatic current tube modulation (ATCM) using a noise index of 15. A total of 135-140 mL of iodinated contrast material (300 mg I/mL) was administered at 5 mL/s via an 18-gauge cannula, and arterial phase scanning was initiated using a bolus-tracking technique. Two observers evaluated image quality of the axial and 3D images and the visibility of branch order in the superior mesenteric artery (SMA) and renal arteries. Attenuation (in Hounsfield units [H]) in the aorta, SMA, and main renal artery was also measured by placing a region of interest. Radiation dose measurements were based on the scanner-generated CT dose index volume (CTDI(vol)). Each parameter tested was compared among the three groups using a nonparametric analysis of variance test, and a p value of 0.05 was considered significant. RESULTS Differences in the quality of the axial images existed between groups A and C (p < 0.001) and between groups B and C (p < 0.01); the image quality of the 3D images and the visibility of branch order in the SMA and renal arteries were comparable for all groups. The difference in mean attenuation of the aorta, SMA, and renal arteries was significant between groups A and C (p < 0.001) and between groups B and C (p < 0.01). All groups had 100% diagnostic accuracy in identifying the number of renal arteries on the side of nephrectomy. The mean radiation dose in CTDI(vol) was 25 +/- 3 mGy at 140 kVp, 17 +/- 4 mGy at 120 kVp, and 12 +/- 3 mGy at 100 kVp (p < 0.001). CONCLUSION Our initial observations suggest that the image quality of 16-MDCT angiography performed at 120 kVp is similar to that of CT angiography (CTA) performed at 140 kVp in adult kidney donors but with a significant radiation dose reduction. CTA at 100 kVp results in higher image noise but provides diagnostically acceptable images with significant radiation dose reduction compared with CTA at 120 or 140 kVp.
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Affiliation(s)
- Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114-2696, USA.
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Abstract
Multidetector CT angiography (MDCTA) is redefining traditional imaging strategies of the vascular structures of the abdomen. Angiographic depiction of normal and variant anatomy is becoming the standard for evaluation and has a significant impact in transplant and oncologic surgery. MDCTA is increasingly being used for assessing diseases affecting the vasculature of the abdominal organs, including the abdominal aorta for treatment planning and post therapy follow-up.
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Affiliation(s)
- Preet S Kang
- Case Western Reserve University, Cleveland, OH, USA.
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