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Poliarterite Nodosa , Humanos , Masculino , Poliarterite Nodosa/complicações , Poliarterite Nodosa/diagnóstico por imagem , Poliarterite Nodosa/tratamento farmacológico , Poliarterite Nodosa/patologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Angiografia , Artérias/diagnóstico por imagem , Abdome/irrigação sanguínea , Abdome/diagnóstico por imagem , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Ciclofosfamida/uso terapêutico , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Administração OralRESUMO
Non-invasive neuromodulation of non-compressible internal organs has significant potential for internal organ bleeding and blood-shift in aero/space medicine. The present study aims to investigate the potential influences of the non-invasive transcutaneous electrical nerve stimulation (TENS) on multiple non-compressible internal organs' blood flow. Porcine animal model (n = 8) was randomized for a total of 48 neuromodulation sessions with two different TENS stimulation frequencies (80 Hz, 10 Hz) and a placebo stimulation. A combination of two different electrode configurations (Abdominal-only or Abdominal and hind limb) were also performed. Intraarterial blood flow measurements were taken during pre and post-stimulation periods at the left renal artery, common hepatic artery, and left coronary artery. Intracranial, and extracranial arterial blood flows were also assessed with digital subtraction angiography. TENS with abdominal-only electrode configurations at 10 Hz demonstrated significant reductions in average peak blood flow velocity (APV) of the common hepatic artery (p = 0.0233) and renal arteries (p = 0.0493). Arterial pressures (p = 0.0221) were also significantly lower when renal APV was reduced. The outcome of the present study emphasises the potential use of TENS in decreasing the blood flow of non-compressible internal organs when the correct combination of electrodes configuration and frequency is used.
Assuntos
Estimulação Elétrica Nervosa Transcutânea , Animais , Estimulação Elétrica Nervosa Transcutânea/métodos , Suínos , Artéria Renal/fisiologia , Velocidade do Fluxo Sanguíneo , Artéria Hepática/fisiologia , Abdome/irrigação sanguínea , Fluxo Sanguíneo RegionalRESUMO
OBJECTIVES: To compare vascular scanning parameters (vessel diameter, peak systolic velocity, end-diastolic velocity, and resistive index) and scanning time before and after breathing control training program for selected abdominal vessels. METHODS: This study was pre and post quasi-experimental. The researchers designed a breathing training program that gives participants instructions through a video describing breathing maneuvers. Data were collected at the ultrasound laboratory/College of Health and Rehabilitation Sciences in Princess Nourah bint Abdul Rahman University, Riyadh, Saudi Arabia from January 2023 to November 2023. About 49 volunteers at the university participated in the study. Scanning was performed two times for the right renal artery, upper abdominal aorta, inferior vena cava, and superior mesenteric artery. Scanning time was measured before and after the program as well. A paired sample t-test was used to compare the parameters means and time before and after the program. RESULTS: The program had a significant effect on the following parameters: right renal artery peak systolic velocity (p=0.042), upper abdominal aortic peak systolic velocity, and resistive index (p=0.014, p=0.014 respectively), superior mesenteric artery and inferior vena cava diameters (p=0.010 and p=0.020). The scanning time was reduced significantly (p<0.001). CONCLUSION: The breathing training program saves time and improves ultrasound measurement quality. Hospitals and health centers should consider the importance of breathing control training programs before abdominal scanning.
Assuntos
Aorta Abdominal , Artéria Renal , Ultrassonografia , Veia Cava Inferior , Humanos , Masculino , Ultrassonografia/métodos , Feminino , Adulto , Aorta Abdominal/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem , Artéria Renal/diagnóstico por imagem , Abdome/diagnóstico por imagem , Abdome/irrigação sanguínea , Artéria Mesentérica Superior/diagnóstico por imagem , Adulto Jovem , Exercícios Respiratórios/métodos , Velocidade do Fluxo Sanguíneo , Arábia Saudita , RespiraçãoRESUMO
Vascular compression syndromes are a diverse group of pathologies that can manifest asymptomatically and incidentally in otherwise healthy individuals or symptomatically with a spectrum of presentations. Due to their relative rarity, these syndromes are often poorly understood and overlooked. Early identification of these syndromes can have a significant impact on subsequent clinical management. This pictorial review provides a concise summary of seven vascular compression syndromes within the abdomen and pelvis including median arcuate ligament (MAL) syndrome, superior mesenteric artery (SMA) syndrome, nutcracker syndrome (NCS), May-Thurner syndrome (MTS), ureteropelvic junction obstruction (UPJO), vascular compression of the ureter, and portal biliopathy. The demographics, pathophysiology, predisposing factors, and expected treatment for each compression syndrome are reviewed. Salient imaging features of each entity are illustrated through imaging examples using multiple modalities including ultrasound, fluoroscopy, CT, and MRI.
Assuntos
Síndrome do Quebra-Nozes , Humanos , Síndrome do Quebra-Nozes/diagnóstico por imagem , Síndrome do Ligamento Arqueado Mediano/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Abdome/diagnóstico por imagem , Abdome/irrigação sanguínea , Diagnóstico Diferencial , Doenças Vasculares/diagnóstico por imagem , Pelve/diagnóstico por imagem , Pelve/irrigação sanguínea , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/complicações , Síndrome da Artéria Mesentérica Superior/diagnóstico por imagemRESUMO
Ferumoxytol is an ultrasmall superparamagnetic iron oxide which has been used as an off-label intravenous contrast agent for MRI. Unlike gadolinium-based contrast agents, ferumoxytol remains in the intravascular space with a long half-life of 14-21 h. During the first several hours, it acts as a blood-pool agent and has minimal parenchymal enhancement. Studies have shown adequate intravascular signal for up to 72 h after initial contrast bolus. Ferumoxytol has been shown to be safe, even in patients with renal failure. Ferumoxytol has shown promise in a variety of clinical settings. The exquisite resolution enabled by the long intravascular times and lack of background parenchymal enhancement is of particular interest in the vascular imaging of solid organ allografts. Ferumoxytol magnetic resonance angiography (MRA) may identify clinically actionable findings months before ultrasound, CT angiography, or Gadolinium-enhanced MRA. Ferumoxytol MRA is of particular benefit as a troubleshooting tool in the setting of equivocal ultrasound and CT imaging. In the following review, we highlight the use of ferumoxytol for high-resolution MR vascular imaging for abdominal solid organ allografts, with representative cases.
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Meios de Contraste , Óxido Ferroso-Férrico , Angiografia por Ressonância Magnética , Humanos , Angiografia por Ressonância Magnética/métodos , Abdome/diagnóstico por imagem , Abdome/irrigação sanguínea , AloenxertosRESUMO
The inferior epigastric artery (IEA) is commonly used as a recipient vessel in microsurgical phalloplasty but its use can be associated with abdominal parietal complications (hernia, bulging). To preclude such complications and avoid involvement of the femoral artery, we assessed an external pudendal artery (EPA) as a recipient vessel. We studied the disposition of the external pudendal system and its general anatomy. Then we compared the external diameter of the EPA to that of the first branches of the femoral artery. The most important point was to determine the location of the EPA through a reference line to facilitate a surgical approach. We then illustrated this preliminary study with a clinical case to check the reliability of the identified landmarks. Ten adult cadavers were dissected. The arteries of interest were part of a system consisting of either a common trunk or a duplicated system. The branches of the pudendal system arose from either the femoral artery or the deep femoral artery. On a horizontal reference line passing through the two pubic tubercles, we observed that 83% of EPAs arose between the reference line and 3 cm below it, at the level of a vertical axis centered on the femoral artery. The EPA could be suitable as recipient vessel in phalloplasty owing to its location, size, and ease of dissection. Using it instead of the IEA precludes abdominal parietal complications and reduces scarring in the recipient area.
Assuntos
Artéria Femoral , Faloplastia , Adulto , Humanos , Reprodutibilidade dos Testes , Artéria Femoral/cirurgia , Artéria Femoral/anatomia & histologia , Artérias Epigástricas/cirurgia , Artérias Epigástricas/anatomia & histologia , Abdome/irrigação sanguíneaRESUMO
4D flow MRI is a quantitative MRI technique that allows the comprehensive assessment of time-resolved hemodynamics and vascular anatomy over a 3-dimensional imaging volume. It effectively combines several advantages of invasive and non-invasive imaging modalities like ultrasound, angiography, and computed tomography in a single MRI acquisition and provides an unprecedented characterization of velocity fields acquired non-invasively in vivo. Functional and morphological imaging of the abdominal vasculature is especially challenging due to its complex and variable anatomy with a wide range of vessel calibers and flow velocities and the need for large volumetric coverage. Despite these challenges, 4D flow MRI is a promising diagnostic and prognostic tool as many pathologies in the abdomen are associated with changes of either hemodynamics or morphology of arteries, veins, or the portal venous system. In this review article, we will discuss technical aspects of the implementation of abdominal 4D flow MRI ranging from patient preparation and acquisition protocol over post-processing and quality control to final data analysis. In recent years, the range of applications for 4D flow in the abdomen has increased profoundly. Therefore, we will review potential clinical applications and address their clinical importance, relevant quantitative and qualitative parameters, and unmet challenges.
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Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Abdome/irrigação sanguínea , Abdome/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo , Hemodinâmica , Humanos , Imageamento Tridimensional/métodos , Angiografia por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/métodosRESUMO
Background Four-dimensional (4D) flow MRI has the potential to provide hemodynamic insights for a variety of abdominopelvic vascular diseases, but its clinical utility is currently impaired by background phase error, which can be challenging to correct. Purpose To assess the feasibility of using deep learning to automatically perform image-based background phase error correction in 4D flow MRI and to compare its effectiveness relative to manual image-based correction. Materials and Methods A convenience sample of 139 abdominopelvic 4D flow MRI acquisitions performed between January 2016 and July 2020 was retrospectively collected. Manual phase error correction was performed using dedicated imaging software and served as the reference standard. After reserving 40 examinations for testing, the remaining examinations were randomly divided into training (86% [85 of 99]) and validation (14% [14 of 99]) data sets to train a multichannel three-dimensional U-Net convolutional neural network. Flow measurements were obtained for the infrarenal aorta, common iliac arteries, common iliac veins, and inferior vena cava. Statistical analyses included Pearson correlation, Bland-Altman analysis, and F tests with Bonferroni correction. Results A total of 139 patients (mean age, 47 years ± 14 [standard deviation]; 108 women) were included. Inflow-outflow correlation improved after manual correction (ρ = 0.94, P < .001) compared with that before correction (ρ = 0.50, P < .001). Automated correction showed similar results (ρ = 0.91, P < .001) and demonstrated very strong correlation with manual correction (ρ = 0.98, P < .001). Both correction methods reduced inflow-outflow variance, improving mean difference from -0.14 L/min (95% limits of agreement: -1.61, 1.32) (uncorrected) to 0.05 L/min (95% limits of agreement: -0.32, 0.42) (manually corrected) and 0.05 L/min (95% limits of agreement: -0.38, 0.49) (automatically corrected). There was no significant difference in inflow-outflow variance between manual and automated correction methods (P = .10). Conclusion Deep learning automated phase error correction reduced inflow-outflow bias and variance of volumetric flow measurements in four-dimensional flow MRI, achieving results comparable with manual image-based phase error correction. © RSNA, 2021 See also the editorial by Roldán-Alzate and Grist in this issue.
Assuntos
Abdome/irrigação sanguínea , Aprendizado Profundo , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Doenças Vasculares/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVE: Case reports and small case series suggest that stenotic lesions of the renal, coeliac and mesenteric arteries may occur in the antiphospholipid syndrome (APS) resulting in clinical consequences such as hypertension and abdominal angina. The objective was to determine the prevalence of stenotic lesions in arteries arising from the middle aorta in patients with antiphospholipid antibodies (aPL) compared with healthy, hypertensive and atherosclerotic controls. METHODS: In a cross-sectional comparative radiological study using magnetic resonance angiography (MRA), we assessed five groups of subjects for the prevalence of stenotic lesions in arteries arising from the middle aorta: APS/aPL positive, healthy renal donors, patients with hypertension, patients with atherosclerosis defined radiologically and patients with systemic lupus erythematosus and vasculitis who were negative for aPL. All subjects underwent MRA in suspended respiration and images were assessed by two senior radiologists blinded to the clinical details. RESULTS: In the atherosclerosis group, vascular stenotic lesions were more prevalent (71%) than in any other group (P ≤0.000002). The prevalence of all stenotic lesions in aPL positive patients (33%) was significantly higher than in the renal donors (18%) and hypertensive patients (19%) (P ≤0.009). Renal artery stenosis was significantly more prevalent in aPL positive patients than in renal donors (P ≤0.0006) but similar to the prevalence in hypertensive patients. Coeliac and/or mesenteric lesions were significantly more common in aPL positive patients vs hypertensive patients (P ≤0.001). Stenoses did not correlate with traditional risk factors. CONCLUSION: Arterial stenotic lesions in arteries arising from the middle aorta were highly prevalent in atherosclerotic subjects and were more common in aPL-positive patients than in hypertensive patients and healthy renal donors.
Assuntos
Abdome/irrigação sanguínea , Anticorpos Antifosfolipídeos/sangue , Arteriopatias Oclusivas/etiologia , Adolescente , Adulto , Idoso , Síndrome Antifosfolipídica/complicações , Arteriopatias Oclusivas/sangue , Arteriopatias Oclusivas/diagnóstico por imagem , Artérias/diagnóstico por imagem , Estudos de Casos e Controles , Artéria Celíaca/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Hipertensão/complicações , Lúpus Eritematoso Sistêmico/complicações , Angiografia por Ressonância Magnética , Masculino , Artérias Mesentéricas/diagnóstico por imagem , Pessoa de Meia-Idade , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/etiologia , Fatores de Risco , Adulto JovemRESUMO
Abdominal vascular emergencies are an uncommon entity in emergency medicine, but when they present, they are often catastrophic. These time-sensitive and life-threatening diagnoses are often hidden in nonspecific complaints such as nausea, vomiting, or flank pain, so the emergency physician must remain diligent and consider these in the differential diagnoses. The following is an overview of the more common of these abdominal vascular emergencies, in the hope that they help the Emergency Physician avoid the misdiagnosis and subsequent vascular catastrophe that would follow.
Assuntos
Abdome/irrigação sanguínea , Erros de Diagnóstico/prevenção & controle , Traumatismos Abdominais/diagnóstico , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Estenose da Valva Aórtica/diagnóstico , Arteriopatias Oclusivas/diagnóstico , Técnicas de Diagnóstico do Sistema Digestório , Medicina de Emergência , Humanos , Intestinos/irrigação sanguínea , Isquemia/diagnóstico , Isquemia/terapia , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/terapia , Lesões do Sistema Vascular/diagnósticoRESUMO
BACKGROUND: Preoperative abdominal computed tomographic angiograms for free flap breast reconstruction improve operative safety and efficiency, but incidental findings are common and potentially affect management. In addition, the authors hypothesized that patients with genetic mutations might have a higher rate of significant findings. The authors present the largest series of computed tomographic angiogram "incidentalomas" in these two populations and an evidence-based algorithm for managing common findings. METHODS: All patients undergoing free flap breast reconstruction at Northwell Health between 2009 and 2017 were eligible. Medical history, perioperative details, and radiology reports were examined with abnormal findings recorded. Published literature was reviewed with radiologists to develop standardized guidelines for incidentaloma management. RESULTS: Of 805 patients included, 733 patients had abdominal imaging. One hundred ninety-five (27 percent) had a completely negative examination. In the remaining 538 patients, benign hepatic (22 percent) and renal (17 percent) findings were most common. Sixteen patients (2.2 percent) required additional imaging (n = 15) or procedures (n = 5). One finding was concerning for malignancy-renal cell carcinoma-which interventional radiology ablated postoperatively. Seventy-nine patients (10.8 percent) had a genetic mutation but were not found to have a statistically significant higher rate of incidentalomas. CONCLUSIONS: The authors' rate of computed tomographic angiography incidental findings (73 percent) is consistent with previous studies, but the rate requiring further intervention (2.2 percent) is lower. Incidental findings were no more common or pathologic among genetic mutation carriers. The authors also introduce an evidence-based algorithm for the management of common incidentalomas. Using these guidelines, plastic surgeons can reassure patients, regardless of mutation status, that incidentalomas are most commonly benign and have minimal impact on their surgical plan.
Assuntos
Abdome/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Angiografia por Tomografia Computadorizada , Retalhos de Tecido Biológico/transplante , Achados Incidentais , Abdome/irrigação sanguínea , Adulto , Idoso , Neoplasias da Mama/genética , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Mutação , Cuidados Pré-Operatórios , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVES: To assess the feasibility of whole-body dual-energy computed tomographic angiography (DECTA) at 40 keV with 50% reduced iodine dose protocol. METHODS: Whole-body CTA was performed in 65 patients; 31 of these patients underwent 120 kVp single-energy computed tomographic angiography (SECTA) with standard iodine dose (600 mgI/kg) and 34 with 40 keV DECTA with 50% reduced iodine dose (300 mgI/kg). SECTA data were reconstructed with adaptive statistical iterative reconstruction of 40% (SECTA group), and DECTA data were reconstructed with adaptive statistical iterative reconstruction of 40% (DECTA-40% group) and 80% (DECTA-80% group). CT numbers of the thoracic and abdominal aorta, iliac artery, background noise, signal-to-noise ratio (SNR), and arterial depiction were compared among the three groups. The CT dose index volumes (CTDIvol) for the thorax, abdomen, and pelvis were compared between SECTA and DECTA protocols. RESULTS: The vascular CT numbers and background noise were found to be significantly higher in DECTA groups than in the SECTA group (p < 0.001). SNR was significantly higher in the order corresponding to DECTA-80%, SECTA, and DECTA-40% (p < 0.001). The arterial depiction was comparable in almost all arteries; however, intrapelvic arterial depiction was significantly worse in DECTA groups than in the SECTA group (p < 0.0001-0.017). Unlike the pelvic region (p = 0.055), CTDIvol for the thorax (p < 0.0001) and abdomen (p = 0.0031) were significantly higher in the DECTA protocol than in the SECTA protocol. CONCLUSION: DECTA at 40 keV with 50% reduced iodine dose provided higher vascular CT numbers and SNR than SECTA, and almost comparable arterial depiction, but had a degraded intrapelvic arterial depiction and required a larger radiation dose. ADVANCES IN KNOWLEDGE: DECTA enables 50% reduction of iodine dose while maintaining image quality, arterial depiction in almost all arteries, vascular CT numbers, and SNR; however, it does not allow clear visualization of intrapelvic arteries, requiring a slightly larger radiation dose compared with SECTA with standard iodine dose.
Assuntos
Artérias/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Meios de Contraste/administração & dosagem , Iodo/administração & dosagem , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Abdome/irrigação sanguínea , Abdome/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Dissecção Aórtica/diagnóstico por imagem , Aorta Abdominal/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Estatura , Índice de Massa Corporal , Peso Corporal , Estudos de Viabilidade , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pelve/irrigação sanguínea , Pelve/diagnóstico por imagem , Imagens de Fantasmas , Estudos Prospectivos , Doses de Radiação , Exposição à Radiação/análise , Razão Sinal-RuídoRESUMO
PURPOSE: Abdominal arteries differ from the arteries located at the extremities in histological composition and clinical features. This study investigated the distributional pattern of atherosclerosis in arteries of the abdomen and lower extremities and its association with clinical and hematologic factors. PATIENTS AND METHODS: This retrospective study included 227 patients with atherosclerosis who underwent computed tomography angiography (CTA) of the abdomen and lower extremities. The distributional pattern of atherosclerosis was categorized into type 1 (suprainguinal elastic), type 2 (infrainguinal muscular), and type 3 (both arterial involvement). Chi-square tests, Mann-Whitney U-tests, and logistic regression analysis were used to investigate the data. RESULTS: Of the 227 patients, 132 (58%) had type 1 and 95 (42%) had type 3 atherosclerosis. None had type 2. Older age, heavier smoking, and higher levels of HbA1c and homocysteine were the significant risk factors for type 3 atherosclerosis (odds ratio: 1.076, 1.023, 1.426, and 1.130, respectively). Patients with type 3 showed significantly lower right and left ankle and toe brachial indices compared to type 1 (P: 0.029, 0.023, 0.003, and <0.001, respectively). CONCLUSION: In arteries of the abdomen and lower extremities, atherosclerosis may occur initially at suprainguinal elastic arteries. In addition, the significant risk factors for type 3 atherosclerosis may contribute to the development of atherosclerosis at infrainguinal muscular arteries and deteriorate the peripheral arterial circulation. Therefore, if atherosclerotic lesions are found at the suprainguinal elastic arteries on CTA, to prevent atherosclerosis at infrainguinal muscular arteries and subsequent peripheral arterial ischemic disease, cessation of smoking and control of blood glucose and homocysteine may be recommended, especially in elderly patients.
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Abdome/irrigação sanguínea , Artérias/diagnóstico por imagem , Aterosclerose/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Extremidade Inferior/irrigação sanguínea , Placa Aterosclerótica , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/sangue , Aterosclerose/etiologia , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de RiscoRESUMO
The purpose of this article is to describe arterial and venous thromboembolism in the abdomen, pelvis, and lower extremities in patients with coronavirus disease (COVID-19). Eighty-two patients with COVID-19 who underwent abdominal ultrasound or CT were retrospectively compared with 82 patients without COVID-19 for thromboembolism and solid-organ infarction. Nine (11%) patients with COVID-19 had thromboembolic findings, with medium to large arterial thrombi in five. One patient without COVID-19 had known portal vein thrombus on CT. Thromboembolic findings occurred more frequently in patients with than without COVID-19 (p = 0.02).
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COVID-19/complicações , Tromboembolia/diagnóstico por imagem , Tromboembolia/etiologia , Trombofilia , Abdome/irrigação sanguínea , Idoso , Feminino , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , New York , Pelve/irrigação sanguínea , Estudos Retrospectivos , SARS-CoV-2 , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
The purpose of this pictorial essay is to review the imaging appearances of the spectrum of thrombophlebitis of abdominal veins on computed tomography (CT) scans. Thrombophlebitis of abdominal veins is rare but mimics other more common conditions presenting with acute abdomen. Due to non-specific presenting symptoms, signs and laboratory findings, diagnosis is largely reliant on imaging, particularly CT which is readily available in the emergency setting.
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Abdome Agudo/diagnóstico por imagem , Abdome/irrigação sanguínea , Tromboflebite/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Veias/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tromboflebite/terapiaRESUMO
BACKGROUND: Four-dimensional flow magnetic resonance imaging (4D flow MRI) provides volumetric and time-resolved visualization and quantification of blood flow. This review presents an overview of possible applications of 4D flow MRI for non-invasive assessment of abdominal hemodynamics. METHOD: This review is based on the authors' experience and the current literature. A PubMed database literature research was performed in December 2019 focusing on abdominal applications of 4D flow MRI. We illustrated the review with exemplary figures and movies of clinical cases from our institution. RESULTS AND CONCLUSION: 4D flow MRI offers the possibility of comprehensive assessment of abdominal blood flows in different vascular territories and organ systems. Results of recent studies indicate that 4D flow MRI improves understanding of altered hemodynamics in patients with abdominal disease and may be useful for monitoring therapeutic response. Future studies with larger cohorts aiming to integrate 4D flow MRI in the clinical routine setting are needed. KEY POINTS: · 4D flow MRI enables comprehensive visualization of the complex abdominal vasculature. · 4D flow MRI enables quantification of abdominal blood flow velocities and flow rates. · 4D flow MRI may enable deeper understanding of altered hemodynamics in abdominal disease. · Further validation studies are needed prior to broad distribution of abdominal 4D flow MRI. CITATION FORMAT: · Riedel C, Lenz A, Fischer L etâal. Abdominal Applications of 4D Flow MRI. Fortschr Röntgenstr 2021; 193: 388â-â398.
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Abdome , Hemodinâmica , Imageamento por Ressonância Magnética , Abdome/irrigação sanguínea , Abdome/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo , HumanosRESUMO
ABSTRACT: Giant cell arteritis is not an uncommon disease, and its extension is furthermore finely assessed with new-generation PET/CT system. 18F-FDG PET/CT is increasingly used in case of large-vessel vasculitis for optimal diagnosis, activity monitoring (even when treated with interleukin 6 receptor inhibitor), and evaluation damage progression. We reported the case of a 61-year-old woman with common giant cell arteritis pattern on 18F-FDG PET/CT (aorta and large arteries) and uptakes in all aorta branches, mainly impressive and uncommon in the abdomen. After 2 years of therapeutic optimization including IV tocilizumab and monitoring with 18F-FDG PET/CT, a complete metabolical response was assessed.
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Abdome/diagnóstico por imagem , Fluordesoxiglucose F18 , Arterite de Células Gigantes/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Abdome/irrigação sanguínea , Progressão da Doença , Feminino , Seguimentos , Arterite de Células Gigantes/patologia , Humanos , Pessoa de Meia-IdadeRESUMO
Background Previous studies regarding survival in patients with splanchnic vein thrombosis (SVT) are limited. This study measured overall survival in a large cohort of SVTs through linkage to population-based data. Methods and Results Using a previously derived text-search algorithm, we screened the reports of all abdominal ultrasound and contrast-enhanced computed tomography studies at The Ottawa Hospital over 14 years. Screen-positive reports were manually reviewed by at least 2 authors to identify definite SVT cases by consensus. Images of uncertain studies were independently reviewed by 2 radiologists. One thousand five hundred sixty-one adults with SVT (annual incidence ranging from 2.8 to 5.9 cases/10 000 patients) were linked with population-based data sets to measure the presence of concomitant cancer and survival status. Thrombosis involved multiple veins in 314 patients (20.1%), most commonly the portal vein (n=1410, 90.3%). Compared with an age-sex-year matched population, patients with SVT had significantly reduced survival in particular with local cancer (adjusted relative excess risk for recent cases 12.0 [95% CI, 9.8-14.6] and for remote cases 9.7 [7.7-12.2]), distant cancer (relative excess risk for recent cases 5.7 [4.5-7.3] and for remote cases 5.4 [4.4-6.6]), cirrhosis (relative excess risk 8.2 [5.3-12.7]), and previous venous thromboembolism (relative excess risk 3.8 [2.4-6.0]). One hundred fifty (23.9%) of patients >65 years of age were anticoagulated within 1 month of diagnosis. Conclusions SVT is more common than expected. Most patients have cancer and the portal vein is by far the most common vein involved. Compared with the general population, patients with SVT had significantly reduced survival, particularly in patients with concomitant cancer, cirrhosis, and previous venous thromboembolic disease. Most elderly patients did not receive anticoagulant therapy.
Assuntos
Abdome/irrigação sanguínea , Circulação Esplâncnica/fisiologia , Trombose Venosa/etiologia , Trombose Venosa/mortalidade , Abdome/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Anticoagulantes/uso terapêutico , Canadá/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Cirrose Hepática/complicações , Cirrose Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/epidemiologia , Veia Porta/patologia , Análise de Sobrevida , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Tromboembolia Venosa/complicações , Trombose Venosa/tratamento farmacológico , Trombose Venosa/epidemiologiaRESUMO
Current clinical and anatomical studies show that the venous problem associated with the deep inferior epigastric perforator flap results from poor midline-crossing. We examined the venous anatomy of the infraumbilical midline area and the dynamic venous flow of the deep inferior epigastric perforator flap in nine fresh cadavers. All nine abdominal specimens were harvested between the subcostal margin and the groin crease. Two specimens were used to analyze the abdominal venous anatomy, one of which was divided into two hemi-abdominal specimens. The remaining seven specimens were harvested as deep inferior epigastric perforator flaps with one major paraumbilical perforator. Venous cannulation and serial angiographic agent injection were performed in several conditions. Each specimen was radiographed using a soft X-ray system. For additional information, computed tomography (CT) angiography-visualized superficial inferior epigastric veins (SIEVs) and the supraumbilical branch were analyzed. We noted that the venous drainage between the bilateral SIEVs was easier to configure in the supraumbilical area than in the infraumbilical area. Only one to two short polygonal venous networks connect the bilateral superficial inferior epigastric veins in the supraumbilical area; however, long and multiple polygonal venous networks connect the bilateral superficial inferior epigastric veins in the infraumbilical area, which could be a predisposing factor for venous congestion. The mean distance from the umbilicus upper border to evident supraumbilical midline crossover was 18.39±4.03 mm (range: 10.10-28.49) in CT angiograms. In cadaver specimens, the mean distance was 10.87±4.85 mm (range: 4.6-18.9). Supraumbilical midline crossover was more favorable than infraumbilical midline crossover in venous flow.