Dyspnea and hemoptysis revealing Behçet's syndrome: Pulmonary artery aneurysms in a case report.

Behçet's disease is a systemic vasculitis that primarily affects young adults. Arterial involvement in Behçet's disease is rare and associated with a poor prognosis. This manifestation is rarely the initial presentation, often leading to a delayed diagnosis. We present the case of a 27-year-old man who arrived at the emergency department with dyspnea and hemoptysis. An initial chest X-ray revealed bilateral opacities, and subsequent thoracic CT angiography confirmed the presence of pulmonary artery aneurysms. Pulmonary artery involvement, though rare, is a serious condition that manifests as hemoptysis (airway bleeding) caused by pulmonary aneurysms. These aneurysms, often challenging to diagnose, can result in severe hemorrhages and carry a low 2-year survival rate. CT pulmonary angiography is the most effective imaging method for identifying thoracic manifestations of Behçet's disease. Treatment includes early immunosuppression, surgery, or embolization in severe cases, such as those involving massive hemoptysis.

Computed Tomography-Derived Fractional Flow Reserve: Developing A Gold Standard for Coronary Artery Disease Diagnostics.

In recent years, a new technique called computed tomography-derived fractional flow reserve (CT-FFR) has been developed. CT-FFR overcomes many limitations in the current gold-standard fractional flow reserve (FFR) techniques while maintaining a better concordance with FFR. This technique integrates static coronary CT angiography data with hydrodynamic models, employing algorithms rather than guidewire interventions to compute the FFR. In addition to diagnosing coronary heart disease, CT-FFR has been applied in the preoperative risk assessment of major adverse cardiovascular events (MACEs) in organ transplantation and transcatheter aortic valve replacement (TAVR). Continuous advancements in CT-FFR techniques and algorithms are expanding their applicability to other methodologies. Subsequently, with robust clinical trial validation, CT-FFR can potentially supersede FFR as the primary "gatekeeper" for interventions.

The Effect of Leg Dominance in Patients on Perforator-Based Flaps Elevated From the Lower Extremities.

BACKGROUND: The lower extremities are the largest donor sites in the body for perforator flap reconstruction. Multislice row computed tomography angiography allows for a multiplanar assessment of perforators using a large number of three-dimensional images with high resolution. In this study, the effect of leg dominance on perforator flap donor site preference was investigated radiologically to increase preoperative perforator mapping precision and surgical success. PATIENTS AND METHODS: The study included 40 patients. Superior gluteal artery perforator (SGAP) flap, inferior gluteal artery perforator (IGAP) flap, superficial circumflex iliac artery perforator flap, anterolateral thigh (ALT) flap, profunda artery perforator (PAP) flap, medial sural artery perforator (MSAP) flap, peroneal artery perforator (PP) flap, and posterior tibial artery perforator (PTAP) flap were analyzed according to their number of perforators (> 0.8-mm perforators counted, number of larger perforators [nLP]), dominant perforator diameter (DPD), related muscle thickness (RMT), and related subcutaneous tissue thickness (RSTT) in each leg. RESULTS: Of these 40 patients, 35 (87.5%) were right-leg dominant and 5 (12.5%) were left-leg dominant. The dominant leg had higher DPD for MSAP, PTAP, and PP than the nondominant leg (p = 0.08, p = 0.06, and p = 0.06, respectively). The dominant leg had a significantly higher nLP (> 0.8 mm) in MSAP, PTAP, and PP flaps than the nondominant leg (p < 0.05). Except for the PAP flap (adductor magnus muscle; p > 0.05), RMT of all other perforator flaps (SGAP, IGAP, ALT, MSAP, PTAP, and PP) was statistically higher in the dominant leg (p < 0.05). There was no statistically significant difference in RSTT between any of the two groups (p > 0.05). CONCLUSION: According to findings, the dominant leg could be considered a donor site preference to improve surgical outcomes and reduce microsurgical complications due to an increased nLP, perforator diameter, and RMT.

Ultra-high resolution CT angiography for the assessment of intracranial stents and flow diverters using photon counting detector CT.

BACKGROUND: The patency of intracranial stents may not be reliably assessed with either CT angiography or MR angiography due to imaging artifacts. We investigated the potential of ultra-high resolution CT angiography using a photon counting detector (PCD) CT to address this limitation by optimizing scanning and reconstruction parameters. METHODS: A phantom with different flow diverters was used to optimize PCD-CT reconstruction parameters, followed by imaging of 14 patients with intracranial stents using PCD-CT. Images were reconstructed using three kernels based on the phantom results (Hv56, Hv64, and Hv72; Hv=head vascular) and one kernel to virtually match the resolution of standard CT angiography (Hv40). Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measurements were calculated. Subjective image quality and diagnostic confidence (DC) were assessed using a five point visual grading scale (5=best, 1=worst) and a three point grading scale (1=best, 3=worst), respectively, by two independent neuroradiologists. RESULTS: Phantom images demonstrated the highest image quality across dose levels for 0.2 mm reconstructions with Hv56 (4.5), Hv64 (5), and Hv72 (5). In patient images, SNR and CNR decreased significantly with increasing kernel sharpness compared with control parameters. All reconstructions showed significantly higher image quality and DC compared with the control reconstruction with Hv40 kernel (P<0.001), with both image quality and DC being highest with Hv64 (0.2 mm) and Hv72 (0.2 mm) reconstructions. CONCLUSION: Ultra-high resolution PDC-CT angiography provides excellent visualization of intracranial stents, with optimal reconstructions using the Hv64 and the Hv72 kernels at 0.2 mm. REGISTRATION: BASEC 2021-00343.

A cross-sectional analysis of four common clinical decision rules for pulmonary embolism, Mashhad, Iran.

Introduction: Pulmonary embolism (PE) is a potentially fatal condition. Several non-invasive clinical decision rules (CDRs) were developed for the safe exclusion of PE. All CDRs used to safely rule out PE have been created and tested within hospital or acute care environments. However, CDRs that are designed in one specific setting may not perform as effectively when used in a different setting. In this study, we aimed to compare the performance of four common CDRs; Wells Score, Simplified Wells Score, revised Geneva Score, and simplified revised Geneva Score. Methods: This was a cross-sectional study in which patients suspected of PE presenting to Imam Reza Hospital or Ghaem Hospital were recruited from September 23, 2013, to March 19, 2016 in Mashhad, Iran. The specificity, sensitivity, and accuracy were utilized as metrics to compare the CDRs in our region. Results: Two hundred and forty patients were included in the study. The mean age of patients was 57.91±19.97 years, and 54.16% of them (n=130) were female. 120 patients were confirmed to have PE with CT angiography. Wells score showed the highest sensitivity (90.4%) and revised Geneva score represented the highest specificity (84.9%). The highest accuracy belongs to the simplified Wells score (62.3%). Conclusion: In this study, we demonstrated that the Wells criteria with its high sensitivity, can be used as a score for screening, and the revised Geneva score with its high specificity, can be used in the second stage for healthy people who have been diagnosed as unhealthy by the Wells score.

Resection of a giant right coronary artery aneurysm and reconstruction with a saphenous vein graft: a 20-year follow-up-case report.

Background: Coronary artery aneurysms (CAAs) are uncommon and can cause complications such as thrombosis, vessel rupture, or distal embolization. Rarely, CAAs are classified as 'giant', although the defining diameter is debated. The predominant cause of CAAs is atherosclerotic disease. Independently, CAAs constitute an estimated 5-year survival of 71%. Case summary: We report the case of a 56-year-old female who presented 20 years ago with a chest infection when a murmur was auscultated on examination. Subsequently, a coronary angiogram was performed, demonstrating an extensive aneurysm of the right coronary artery (RCA). The aneurysmal segment of the RCA was resected, and a length of saphenous vein was utilized in its reconstruction. Twenty years later, the patient re-presented with dyspnoea, indicating repeat investigations; coronary angiography demonstrated a vein graft 20 years post-reconstruction that is almost indistinguishable from a native RCA. Discussion: The optimal management strategy for CAAs is debatable, and there are no clear guidelines. However, surgical management is generally preferred in cases of GCAAs, which was also the case for this patient. This reconstruction procedure, involving resection of the aneurysmal segment of the RCA and reconstruction with a saphenous vein graft, proved to be a durable and reliable approach, with the saphenous vein graft remaining patent for over 20 years. The 20-year follow-up provides valuable insight into the long-term durability of surgical intervention, allowing for comprehensive assessment of the durability and reliability of this procedure.

Diagnostic and Therapeutic Challenges in Hemosuccus Pancreaticus: A Case Report.

Hemosuccus pancreaticus, also known as pancreatic pseudoaneurysm, is a rare type of upper gastrointestinal bleeding that originates from the major duodenal papilla or ampulla of Vater and extends into the duodenum via the pancreatic duct. By 2021, only 150 cases had been reported worldwide. Without treatment, the mortality rate can be as high as 90%, but it drops to 25%-37% with intervention. We report a case of a 64-year-old woman who experienced intermittent upper gastrointestinal bleeding over a year. Imaging revealed a hematoma and pseudoaneurysm in the pancreas, which was successfully treated with angiographic embolization. This case highlights the value of a multidisciplinary approach, using advanced imaging and minimally invasive techniques like embolization for effective patient outcomes.

The retrotracheal left pulmonary artery: A rare vascular malformation.

The retrotracheal left pulmonary artery, also known as "left pulmonary artery sling," is a rare vascular malformation in which the left pulmonary artery (LPA) arises from the posterior aspect of the right pulmonary artery (RPA) and reaches the left pulmonary hilum by passing between the trachea and the esophagus, giving rise to the appearance of a sling, hence the name "sling." This vascular anomaly can be associated with other cardiac malformations or abnormalities of the tracheobronchial tree.We present the case of a 4-month-old female infant who presented with laryngeal stridor. She underwent a chest X-ray, which was normal, but thoracic CT angiography revealed an aberrant LPA originating from RPA with a retrotracheal course. This case underscores the critical role of imaging in confirming the diagnosis and guiding patient management.

Artificial Intelligence Improves Prediction of Major Adverse Cardiovascular Events in Patients Undergoing Transcatheter Aortic Valve Replacement Planning CT.

RATIONALE AND OBJECTIVES: Coronary CT angiography (CCTA) is mandatory before transcatheter aortic valve replacement (TAVR). Our objective was to evaluate the efficacy of artificial intelligence (AI)-powered software in automatically analyzing cardiac parameters from pre-procedural CCTA to predict major adverse cardiovascular events (MACE) in TAVR patients. MATERIALS AND METHODS: Patients undergoing pre-TAVR CCTA were retrospectively included. AI software automatically extracted 34 morphologic and volumetric cardiac parameters characterizing the ventricles, atria, myocardium, and epicardial adipose tissue. Clinical information and outcomes were recorded from institutional database. Cox regression analysis identified predictors of MACE, including non-fatal myocardial infarction, heart failure hospitalization, unstable angina, and cardiac death. Model performance was evaluated with Harrell's C-index, and nested models were compared using the likelihood ratio test. Manual analysis of 170 patients assessed agreement with automated measurements. RESULTS: Among the 648 enrolled patients (77 ± 9.3 years, 58.9% men), 116 (17.9%) experienced MACE within a median follow-up of 24 months (interquartile range 10-40). After adjusting for clinical parameters, only left ventricle long axis shortening (LV-LAS) was an independent predictor of MACE (hazard ratio [HR], 1.05 [95% confidence interval, 1.05-1.11]; p = 0.04), with significantly improved C-index (0.620 vs. 0.633; p < 0.001). When adjusted for the Society of Thoracic Surgeons Predicted Risk of Mortality score, LV-LAS was also predictive of MACE (HR, 1.08 [95%CI, 1.03-1.13]; p = 0.002), while improving model performance (C-index: 0.557 vs. 0.598; p < 0.001). All parameters showed good or excellent agreement with manual measurements. CONCLUSION: Automated AI-based comprehensive cardiac assessment enables pre-TAVR MACE prediction, with LV-LAS outperforming all other parameters.

Clinically Relevant Extracardiac Findings at Cardiac Imaging: Insights from the European MR/CT Registry.

Purpose To determine the prevalence of clinically relevant extracardiac findings at cardiac CT and MRI examinations from a multicenter, multinational MR/CT registry and the relationship of prevalence with examination indications and patient characteristics. Materials and Methods This was a retrospective analysis of data from the European Society of Cardiovascular Radiology MR/CT Registry. Data from 208 506 cardiac CT examinations (median patient age, 66 years [IQR, 55-77]; 121 617 [58.33%] male patients) and 228 462 cardiac MRI examinations (median patient age, 57 years [IQR, 42-69]; 145 792 [63.81%] male patients) entered into the registry between January 2011 and November 2023 were analyzed. Clinically relevant extracardiac findings were defined as findings requiring follow-up examinations or influencing clinical management. The association of examination indication and patient characteristics, including age, with prevalence of extracardiac findings was evaluated using incidence rate ratios (IRRs) derived from multivariable Poisson regression models. Results The prevalence of clinically relevant extracardiac findings was 3.28% (6832 of 208 506) at cardiac CT and 1.50% (3421 of 228 462) at cardiac MRI examinations. Extracardiac findings were more common at CT examinations performed for transcatheter aortic valve replacement (IRR, 2.07; P < .001) and structural heart disease (IRR, 1.44; P < .001) compared with CT performed for coronary artery disease (IRR, 1; reference). Extracardiac findings were more common at MRI examinations performed for myocarditis (IRR, 1.36; P < .001) and structural heart disease (IRR, 1.16; P < .001) than for coronary artery disease. Older patient age was also significantly associated with higher prevalence of extracardiac findings, with an IRR for both CT and MRI examinations of 1.02 (P < .001). Conclusion Data from the multicenter, multinational MR/CT registry indicate that clinically relevant extracardiac findings are present at cardiovascular CT and MRI examinations, and the prevalence of these findings is associated with examination indication and patient age. Keywords: Cardiac Imaging Techniques, Incidental Findings, MRI, CT Angiography, CT, Heart Disease Supplemental material is available for this article. © RSNA, 2024.

Poor venous outflow is associated with hyperintense acute reperfusion marker on follow-up MRI in patients with acute ischemic stroke with a large vessel occlusion.

BACKGROUND: Hyperintense acute reperfusion marker (HARM) refers to delayed enhancement in the subarachnoid or subpial space on post-contrast fluid attenuated inversion recovery (FLAIR) images. HARM is a measure of blood-brain barrier breakdown, which has been correlated with poor outcomes in patients with acute ischemic stroke with large vessel occlusion (AIS-LVO). We hypothesized that unfavorable venous outflow (VO) would be correlated with HARM after thrombectomy treatment of AIS-LVO. OBJECTIVE: To determine whether poor VO is associated with HARM on follow-up MRI after stroke in patients with AIS-LVO. METHODS: Patients with AIS-LVO from the prospective CRISP2 and DEFUSE2 studies with a baseline CT angiography (CTA) scan and a follow-up MRI with FLAIR sequence were screened for enrollment. VO was measured on the baseline CTA scan using the cortical venous opacification score (COVES). HARM was determined on FLAIR sequences at the follow-up MRI. The primary outcome was the occurrence of HARM between those with good VO (VO+; COVES 3-6) and bad VO (VO-; COVES 0-2). RESULTS: 121 patients were included; 60.3% (n=73) had VO+ and 39.7% (n=48) had VO-. Patients with VO- had higher presentation National Institutes of Health Stroke Scale scores (18 (IQR 12-20) vs 12 (IQR 8-16) in VO+; P<0.001). Middle cerebral artery M1 segment occlusions were more common in VO- patients (65% vs 43% VO+; P=0.028). VO- patients also had a larger pre-treatment ischemic core (23 (4-44) mL vs 12 (3-22) mL in VO+; P=0.049) and Tmax >6 s volumes (105 (72-142) mL vs 66 (35-95) mL in VO+; P<0.001). VO- patients were more likely to develop HARM after thrombectomy (31% vs 10% in VO+; P=0.003). On multivariable regression analysis, VO- (OR=3.6 (95% CI 1.2 to 10.6); P=0.02) and the presence of any ICH (OR=3.6 (95% CI 1.2 to 10.5); P=0.02) were independently associated with the occurrence of HARM. CONCLUSIONS: In patients with AIS-LVO, VO- correlated with HARM on post-thrombectomy MRI.

Median Nerve Palsy Caused by a Brachial Artery Pseudoaneurysm Following an Acute Penetrating Trauma.

Arterial pseudoaneurysms are uncommon vascular lesions resulting from a breach in the arterial wall leading to contained haematoma formation, often associated with trauma or iatrogenic procedures. Brachial artery pseudoaneurysms following acute penetrating trauma are rare, with even fewer cases presenting with associated median nerve complications. We present the case of a 41-year-old man who developed median nerve palsy secondary to a brachial artery pseudoaneurysm following a knife stab wound to his left cubital fossa. Initially, the pseudoaneurysm was undiagnosed, and the patient experienced worsening symptoms, leading to further investigation and subsequent surgical repair of the pseudoaneurysm. This case underscores the importance of considering vascular injuries and their delayed sequelae in cases of penetrating trauma, particularly when associated with neurological deficits. Prompt diagnosis and intervention are crucial to prevent potential complications and optimise patient outcomes. The utilisation of appropriate imaging modalities, such as Doppler ultrasonography and CT angiography, facilitates accurate diagnosis and guides tailored management strategies. Further research is warranted to explore optimal treatment approaches and long-term outcomes in similar cases.

National trends in catheter angiography and cerebrovascular imaging in a group of privately insured patients in the US.

BACKGROUND: Despite the increasing use of non-invasive imaging, DSA remains the gold standard for cerebrovascular imaging. However, trends in DSA utilization are poorly understood. The goal of this study was to describe DSA utilization in a large claims database in the US over a 13 year period. METHODS: This retrospective cohort study assessed a nationwide database of privately insured individuals from 2005 to 2018 for patients undergoing cranial CT angiography (CTA), MR angiography (MRA), and DSA. We assessed trends in the overall use of and indications for each modality. For DSA, we examined the types of performing proceduralists. RESULTS: Among patients undergoing DSA in 2018, median age was 52 years, and 60% were women. MRA and DSA use decreased, from 289 to 275 claims, and from 38 to 29 claims per 100 000 enrollees, respectively, while CTA use increased from 31 to 286 claims per 100 000 enrollees. These trends differed by geographic region and indication. Nearly half of DSA procedures but <25% of non-invasive imaging were inpatient studies. DSA performed by neurosurgeons increased from 0.5 to 4.1 while those performed by radiologists decreased from 7.2 to 4.0 studies per 100 000 enrollees. CONCLUSIONS: DSA use decreased slightly while CTA use increased by ninefold. The reasons for this change are likely complex and may reflect more aggressive imaging for stroke, increased detection of incidental findings, and increased quality of non-invasive imaging. Over time, the proportion of DSA procedures performed by neurosurgeons overtook that performed by radiologists.

Evolving Role of Coronary CT Angiography in Coronary Angiography and Intervention: A State-of-the-Art Review.

PURPOSE OF REVIEW: Despite growing evidence supporting the diagnostic utility of coronary computed tomographic angiography (CCTA) for anatomical assessment of coronary artery disease (CAD), its is underutilized in peri-procedural planning especially in the acute setting. RECENT FINDINGS: Incorporation of flow reserve measurement techniques into CCTA has expanded its sensitivity and specificity for obstructive disease, and continued improvement in CCTA technology permits more accurate cross-sectional plaque characterization. CCTA has the potential to constitute the mainstay of pre-procedural planning for patients with CAD, who are being considered for percutaneous coronary intervention , reducing their ad hoc nature while facilitating equipment selection and improving catheterization lab safety and throughput. Future studies are needed to compare the cost and benefits of more frequent use of routine pre-procedural CCTA prior to coronary angiography and intervention.

A preliminary investigation of the left atrial suspended cord and its significance as revealed by coronary CT angiography: an observational study with a systematic literature review.

BACKGROUND: The occurrence of suspended cords of the left atrium (SCLA) is rare and has seldom been described. The purpose of this study was to summarize the cases of SCLA accidentally detected by coronary CT angiography (CCTA), describe their imaging features, conduct a preliminary analysis of their clinical significance, and review relevant literature. METHODS: A total of 10,796 patients who underwent CCTA examinations from July 2020 to November 2021 were consecutively selected. The original and three-dimensional reconstruction images were reviewed to identify patients with SCLA. A control group was selected in a 1:2 ratio based on age, BMI, sex, and education level. The imaging characteristics and clinical data of the two groups were collected and compared. The case group was divided into two subgroups based on the starting and ending positions of the SCLA: Group 1 with the SCLA between the free wall and free wall, and Group 2 with the SCLA between the septum wall and free wall. The clinical features of these subgroups were compared. Furthermore, a review of literature on SCLA published in the past fifteen years that includes its clinical and imaging features was conducted. RESULTS: In this study, a total of 35 patients were found to have SCLA, resulting in an incidence rate of approximately 0.32%. After excluding 1 patient for whom clinical features could not be obtained, the case group included a total of 18 males and 16 females, with a male-to-female ratio of 1:1 and a median age of 57.00 (52.00-64.00) years. It was found that 19 (55.88%) cases of SCLA were located near the right superior pulmonary vein ostia, while no SCLA was found near the left lower pulmonary vein orifice. A significant difference in the incidence of atrial arrhythmia between the two groups was observed (p = 0.009). Additionally, 3 patients (8.82%) in the SCLA group had a history of transient cerebral ischemic attack (TIA), which was significantly different from that in the control group (p = 0.035). The anteroposterior and transverse diameters of the left atrium were longer in the case group than in the control group (p < 0.05), but there was no significant change in left atrial volume. Subgroup analyses found no significant difference in the incidence of cerebral infarction, atrial arrhythmia, or other intracardiac structural malformations, although there was a significant difference in cord length (p = 0.013), with the length of SCLA in Group 1 and Group 2 being 2.64 ± 0.99 cm and 3.39 ± 0.68 cm, respectively. Notably, only 1 of these 34 patients was diagnosed based on echocardiography, whereas all cases were perfectly visualized using CCTA. CONCLUSION: SCLA is rare. CCTA can accurately detect and depict this abnormal structure as compared to echocardiography. SCLA may be linked to a higher incidence of atrial arrhythmias or transient ischemic attacks. It is important for radiologists and cardiovascular experts to recognize this structure, and further investigation is necessary to determine its clinical significance.

Supra-Aortic Branch Occlusion From Takayasu Arteritis.

This illustration depicts the complete occlusion of all supra-aortic branches due to Takayasu arteritis, as shown in invasive coronary angiography and CT angiography (a) Catheter angiography showing the occluded branches of the aortic arch (*). (b) Sagittal CT angiography showing calcification in the occluded supra-aortic branches (arrows) and thickened aortic wall (dashed arrow).

Trans-umbilical access in the neonate with sheath preservation for intervention.

High-flow vascular malformations in neonates may require emergent embolization to prevent or treat congestive heart failure when intervention is indicated.1 While transfemoral access is the traditional approach, this route may be complicated by the sheath size (typically 4F in our experience, as a smaller sheath system may prove suboptimal) needed for embolization. This is especially true when (1) multiple acute interventions are anticipated during the neonatal period and/or (2) when it is preferred to spare femoral access for future treatments in infancy or childhood.1-3 The safety and feasibility of using transumbilical (TU) access via the umbilical artery and maintaining an indwelling sheath post-procedurally has been previously described and indeed does spare the femoral arteries for later treatments; however, this technique has not yet been sufficiently demonstrated or reported to the extent that it could be easily reproduced.1-10 In this technical video, we detail the required materials and demonstrate a step-by-step guide to obtaining TU access in the context of neonatal vascular malformation embolization. Our practice has utilized this technique for decades and we hope that by sharing our methods with the neurointerventional community we may make this rarely performed procedure a feasible option for proceduralists (see video 1) .neurintsurg;jnis-2024-021561v1/V1F1V1Video 1Technical instructional video for trans-umbilical access in the neonate with sheath preservation for intervention.

Carbohydrate Restriction-Induced Elevations in LDL-Cholesterol and Atherosclerosis: The KETO Trial.

Background: Increases in low-density lipoprotein cholesterol (LDL-C) can occur on carbohydrate restricted ketogenic diets. Lean metabolically healthy individuals with a low triglyceride-to-high-density lipoprotein cholesterol ratio appear particularly susceptible, giving rise to the novel "lean mass hyper-responder" (LMHR) phenotype. Objectives: The purpose of the study was to assess coronary plaque burden in LMHR and near-LMHR individuals with LDL-C ≥190 mg/dL (ketogenic diet [KETO]) compared to matched controls with lower LDL-C from the Miami Heart (MiHeart) cohort. Methods: There were 80 KETO individuals with carbohydrate restriction-induced LDL-C ≥190 mg/dL, high-density lipoprotein cholesterol ≥60 mg/dL, and triglyceride levels ≤80 mg/dL, without familial hypercholesterolemia, matched 1:1 with MiHeart subjects for age, gender, race, hyperlipidemia, hypertension, and smoking status. Coronary artery calcium and coronary computed tomography angiography (CCTA) were used to compare coronary plaque between groups and correlate LDL-C to plaque levels. Results: The matched mean age was 55.5 years, with a mean LDL-C of 272 (maximum LDL-C of 591) mg/dl and a mean 4.7-year duration on a KETO. There was no significant difference in coronary plaque burden in the KETO group as compared to MiHeart controls (mean LDL 123 mg/dL): coronary artery calcium score (median 0 [IQR: 0-56]) vs (1 [IQR: 0-49]) (P = 0.520) CCTA total plaque score (0 [IQR: 0-2] vs [IQR: 0-4]) (P = 0.357). There was also no correlation between LDL-C level and CCTA coronary plaque. Conclusions: Coronary plaque in metabolically healthy individuals with carbohydrate restriction-induced LDL-C ≥190 mg/dL on KETO for a mean of 4.7 years is not greater than a matched cohort with 149 mg/dL lower average LDL-C. There is no association between LDL-C and plaque burden in either cohort. (Diet-induced Elevations in LDL-C and Progression of Atherosclerosis [Keto-CTA]; NCT057333255).

Atypical Presentation of Tertiary Syphilis.

Syphilis is a sexually transmitted infection characterized by multiple stages. Cardiovascular involvement is a manifestation of tertiary syphilis, occurring between 10 and 40 years after the primary infection. The authors present a case of atypical presentation of tertiary syphilis in a 49-year-old male patient who was admitted to the hospital with bilateral transient loss of vision. Contrast-enhanced CT imaging revealed thoracic aortitis with carotid occlusion, coronary artery stenosis, ischemic stroke, myocardial infarction, and multiple intracardiac thrombi. A postmortem autopsy revealed positive laboratory results for syphilis, which was corroborated by medical autopsy findings of syphilitic aortitis. Keywords: CT-Angiography, Aorta, Cardiac, Vascular, Tertiary Syphilis © RSNA, 2024.