RESUMEN
To examine the feasibility of the quantification of abdominal periaortic fat tissue (PaFT) (tissue within - 45 to - 195 HU) in enhanced CT-angiographies compared to unenhanced CT-scans and identify methodological issues affecting its clinical implementation. Using OsirixMD, PaFT volume and mean HU value were retrospectively measured within a 5 mm periaortic ring in paired unenhanced and enhanced abdominal aortic CT-scans. The correlation between PaFT values was examined in a derivation cohort (n = 101) and linear regression analysis produced correction factors to convert values from enhanced into values from unenhanced CTs. The conversion factors were then applied to enhanced CTs in a different validation cohort (n = 47) and agreement of corrected enhanced values with values from unenhanced scans was evaluated. Correlation between PaFT Volume und Mean HU from enhanced and unenhanced scans was very high (r > 0.99 and r = 0.95, respectively, p < 0.0001 for both). The correction factors for PaFT Volume and Mean HU were 1.1057 and 1.0011. Potential confounding factors (CT-kilovoltage, slice thickness, mean intraluminal contrast density, aortic wall calcification, longitudinal variation of intraluminal contrast density, aortic diameter) showed no significant effect in a multivariate regression analysis (p > 0.05). Bland-Altman analysis of corrected enhanced and unenhanced values showed excellent agreement and Passing-Bablok regression confirmed minimal/no residual bias. PaFT can be quantified in enhanced CT-angiographies very reliably. PaFT Volume scores are very consistently slightly underestimated in enhanced scans by about 10%, while the PaFT Mean HU value remains practically constant and offers distinct methodological advantages. However, a number of methodological issues remain to be addressed.
RESUMEN
A right-sided aortic arch is a rare anomaly with an incidence of 0.1% worldwide and is usually associated with a mirror image of all supra-aortic branches or an aberrant left subclavian artery. The latter is often associated with a Kommerell diverticulum, although it can rarely be hypoplastic or atretic and lead to congenital subclavian steal. In most patients, the situation is well-tolerated. In this report, we present a case of subclavian steal syndrome with multiple cerebellar infarcts in a patient with an atypical right-sided aortic arch and an atretic aberrant left subclavian artery arising from a left-sided descending thoracic aorta.
Asunto(s)
Aneurisma/complicaciones , Aorta Torácica/anomalías , Anomalías Cardiovasculares/complicaciones , Infarto Cerebral/etiología , Trastornos de Deglución/complicaciones , Arteria Subclavia/anomalías , Síndrome del Robo de la Subclavia/etiología , Aneurisma/diagnóstico , Aneurisma/cirugía , Aortografía/métodos , Anomalías Cardiovasculares/diagnóstico , Anomalías Cardiovasculares/cirugía , Angiografía Cerebral/métodos , Infarto Cerebral/diagnóstico , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/cirugía , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Arteria Subclavia/cirugía , Síndrome del Robo de la Subclavia/diagnóstico , Síndrome del Robo de la Subclavia/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Retrograde ascending aortic dissections usually complicate endovascular reconstructions of Stanford B dissections. Although rare, with an incidence of 1.3% to 6.8%, they are catastrophic, with a high mortality rate of up to 42%. The exact mechanism is not known, but all indications point to a mechanical interaction between the tips of the proximal bare stent and a fragile aortic wall. Practically all reported cases involve dissections of the thoracic aorta. We report a patient with an asymptomatic retrograde ascending aortic dissection that originated at the level of a damaged suprarenal stent during capture tip retrieval during a routine endovascular aneurysm repair to treat an infrarenal aortic aneurysm.