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Nepal P, VanBuren W, Khandelwal K, Mileto A, Potrezke T, Khandelwal A. Problem-solving with MRI in acute abdominopelvic conditions, part 2: gynecological, obstetric, vascular, and renal diseases. Emerg Radiol 2021; 28:1173-1183. [PMID: 34287728 DOI: 10.1007/s10140-021-01961-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/25/2021] [Indexed: 12/13/2022]
Abstract
The purpose of this article is to illustrate the benefits of magnetic resonance imaging (MRI) in the setting of abdominopelvic emergencies. Owing to intrinsically high soft-tissue contrast resolution, and ability to resolve different soft tissue, MRI holds notable advantages over other imaging modalities and can be used as a problem-solving tool. Additional advantages of MRI include lack of radiation-related risks to children and pregnant women, and the ability to acquire detailed diagnostic information even without intravenous contrast which can be beneficial in patients with contrast allergy and end-stage renal disease. In the part 2, the authors focus on MRI features of female pelvic gynecological diseases, pregnancy- related complications, abdominal vascular complications, and renal diseases.
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Affiliation(s)
- Pankaj Nepal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Wendaline VanBuren
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kanika Khandelwal
- Department of Hospital Internal Medicine, Mayo Clinic, Austin, MN, USA
| | - Achille Mileto
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Theodora Potrezke
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ashish Khandelwal
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, 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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Zelaya JE, Goenezen S, Dargon PT, Azarbal AF, Rugonyi S. Improving the efficiency of abdominal aortic aneurysm wall stress computations. PLoS One 2014; 9:e101353. [PMID: 25007052 PMCID: PMC4090134 DOI: 10.1371/journal.pone.0101353] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 06/05/2014] [Indexed: 12/31/2022] Open
Abstract
An abdominal aortic aneurysm is a pathological dilation of the abdominal aorta, which carries a high mortality rate if ruptured. The most commonly used surrogate marker of rupture risk is the maximal transverse diameter of the aneurysm. More recent studies suggest that wall stress from models of patient-specific aneurysm geometries extracted, for instance, from computed tomography images may be a more accurate predictor of rupture risk and an important factor in AAA size progression. However, quantification of wall stress is typically computationally intensive and time-consuming, mainly due to the nonlinear mechanical behavior of the abdominal aortic aneurysm walls. These difficulties have limited the potential of computational models in clinical practice. To facilitate computation of wall stresses, we propose to use a linear approach that ensures equilibrium of wall stresses in the aneurysms. This proposed linear model approach is easy to implement and eliminates the burden of nonlinear computations. To assess the accuracy of our proposed approach to compute wall stresses, results from idealized and patient-specific model simulations were compared to those obtained using conventional approaches and to those of a hypothetical, reference abdominal aortic aneurysm model. For the reference model, wall mechanical properties and the initial unloaded and unstressed configuration were assumed to be known, and the resulting wall stresses were used as reference for comparison. Our proposed linear approach accurately approximates wall stresses for varying model geometries and wall material properties. Our findings suggest that the proposed linear approach could be used as an effective, efficient, easy-to-use clinical tool to estimate patient-specific wall stresses.
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MESH Headings
- Algorithms
- Aorta, Abdominal/pathology
- Aorta, Abdominal/physiopathology
- Aortic Aneurysm, Abdominal/diagnosis
- Aortic Aneurysm, Abdominal/physiopathology
- Humans
- Linear Models
- Models, Biological
- Muscle, Smooth, Vascular/pathology
- Muscle, Smooth, Vascular/physiopathology
- Quality Improvement
- Risk
- Risk Assessment
- Severity of Illness Index
- Stress, Physiological
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Affiliation(s)
- Jaime E. Zelaya
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Sevan Goenezen
- Department of Mechanical Engineering, Texas A & M University, College Station, Texas, United States of America
| | - Phong T. Dargon
- Department of Surgery, Division of Vascular Surgery, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Amir-Farzin Azarbal
- Department of Surgery, Division of Vascular Surgery, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Sandra Rugonyi
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, United States of America
- * E-mail:
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4
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Systematic review and meta-analysis of remote ischaemic preconditioning in percutaneous coronary intervention. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.ijcme.2013.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [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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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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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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Saida T, Mori K, Sato F, Shindo M, Takahashi H, Takahashi N, Sakakibara Y, Minami M. Prospective intraindividual comparison of unenhanced magnetic resonance imaging vs contrast-enhanced computed tomography for the planning of endovascular abdominal aortic aneurysm repair. J Vasc Surg 2012; 55:679-87. [DOI: 10.1016/j.jvs.2011.09.091] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 09/26/2011] [Accepted: 09/26/2011] [Indexed: 11/17/2022]
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Attenberger UI, Michaely HJ, Schoenberg SO, Rieger J. Imaging of non-atherosclerotic aneurysmal disease. Eur J Radiol 2011; 80:41-9. [DOI: 10.1016/j.ejrad.2010.12.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 12/29/2010] [Indexed: 10/18/2022]
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Unenhanced MR Angiography of the Thoracic Aorta: Initial Clinical Evaluation. AJR Am J Roentgenol 2008; 190:902-6. [DOI: 10.2214/ajr.07.2997] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Krishnam MS, Tomasian A, Lohan DG, Tran L, Finn JP, Ruehm SG. Low-dose, time-resolved, contrast-enhanced 3D MR angiography in cardiac and vascular diseases: correlation to high spatial resolution 3D contrast-enhanced MRA. Clin Radiol 2008; 63:744-55. [PMID: 18555032 DOI: 10.1016/j.crad.2008.01.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Revised: 12/22/2007] [Accepted: 01/03/2008] [Indexed: 11/20/2022]
Abstract
AIM To evaluate the effectiveness of low-dose, contrast-enhanced, time-resolved, three-dimensional (3D) magnetic resonance (MR) angiography (TR-MRA) in the assessment of various cardiac and vascular diseases, and to compare the results with high-resolution contrast-enhanced MRA (CE-MRA). MATERIALS AND METHODS Thirty consecutive patients underwent contrast-enhanced 3D TR-MRA and high spatial resolution 3D CE-MRA for evaluation of cardiac and thoracic vascular diseases at 1.5 T, and neurovascular, abdominal and peripheral vascular diseases at 3T. Gadolinium-based contrast medium was administered at a constant dose of 5 ml for TR-MRA, and 20 ml (lower extremity 30 ml) for CE-MRA. Two readers evaluated image quality using a four-point scale (from 0=excellent to 3=non-diagnostic), artefacts and findings on both datasets. Interobserver variability was tested with kappa coefficient. RESULTS The overall image quality for TR-MRA was in the diagnostic range (median 0, range 0-1; k=0.74). Readers demonstrated important additional dynamic information on TR-MRA in 28 of 30 patients (k=0.84). Confident evaluation of organ perfusion (n=23), arteriovenous malformation/fistula flow patterns (n=7), exclusion of intra-cardiac shunts (n=6), and assessment of stent and conduit patency (n=5) were performed by both readers using TR-MRA. Readers demonstrated fine vascular details with higher confidence in 10 patients on CE-MRA. Using CE-MRA, Reader 1 and 2 depicted anatomical details in 6 and 5 patients, respectively, only on CE-MRA. CONCLUSION Low-dose TR-MRA yields rapid and important functional and anatomical information in patients with cardiac and vascular diseases. Due to limited spatial resolution, TR-MRA is inferior to CE-MRA in demonstrating fine vascular details.
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Affiliation(s)
- M S Krishnam
- Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA 90095-7206, USA.
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Ince H, Nienaber CA. Etiology, pathogenesis and management of thoracic aortic aneurysm. ACTA ACUST UNITED AC 2007; 4:418-27. [PMID: 17653114 DOI: 10.1038/ncpcardio0937] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 04/12/2007] [Indexed: 01/15/2023]
Abstract
Given the growing proportion of elderly people in Western societies and the increasing prevalence of chronic hypertension, the management of aneurysmal aortic disease is an ever growing challenge. Although degenerative changes in the aortic wall are common to thoracic aortic aneurysm (TAA) and to various types of dissection in general, TAA can result from specific heritable disorders of connective tissues. Today, increased awareness of vascular diseases and access to tomographic imaging equipment facilitate the diagnosis of TAA, even when asymptomatic. While most TAA cases with ascending aortic involvement are treated with surgical repair (primarily valve-preserving techniques), aneurysms of the distal arch and descending thoracic aorta are amenable to alternatives to classic open repair such as the emerging endovascular treatment techniques. In this Review, we provide a comprehensive overview of the etiology, pathophysiology and clinical management of patients with TAA, and discuss the most recent literature on the condition.
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Affiliation(s)
- Hüseyin Ince
- Division of Cardiology, University Hospital Rostock, Rostock School of Medicine, Rostock, Germany
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