Excessive brain atrophy in patients with severe aortic stenosis.

Purpose: To assess the prevalence of the neuroradiological indices of brain atrophy in patients with severe aortic valve stenosis (AS) in magnetic resonance imaging (MRI) with particular emphasis on the assessment of atrophy areas typical of cerebral small vessel disease (CSVD). Material and methods: The group of 34 patients (age 60-90 years, 17 women and 17 men) with severe AS and 50 healthy controls (age 61-85 years, 29 women and 21 men) underwent MRI brain examinations, which were analysed for the neuroradiological indices of brain atrophy. Results: A slight but statistically significant age difference was found between the study and control groups - about 3 years on average (p = 0.040). Differences between total brain volumes in both the groups did not show statistical significance. In a comparative analysis of the main brain compartments, a statistically significant difference was found only in the volumetry of cerebral hemispheres for both the groups: mean volume of cerebral hemispheres in patients with severe AS was 884.46 cm3, while it was 17 cm3 bigger in the volunteer group, reaching 901.80 cm3 on average (p = 0.043). Comparison of the volumetry of the other major and minor regions and structures according to the clinical and anatomical division revealed statistically non-significant differences. No statistically significant relationships were observed concerning structures correlated with CSVD. Conclusions: Neuroradiological indices of the brain atrophy do not provide an unequivocal distinction in patients with severe AS. Most observations imply that brain atrophy in patients with severe AS is primarily a consequence of physiological ageing of the brain.

Magnetic resonance imaging assessment of cerebral small vessel disease intensification in patients with severe aortic valve stenosis.

PURPOSE: To assess the prevalence of the neuroradiological indices of cerebral small vessel disease (CSVD) in patients with severe aortic valve stenosis (AS) in magnetic resonance imaging (MRI). MATERIAL AND METHODS: 34 patients (age 60-90 years, 17 women and 17 men) with severe AS and 50 healthy controls (age 61-85 years, 29 women and 21 men) underwent MRI brain examinations, which were analysed for the neuroradiological indices of CSVD: hyperintensities in periventricular white matter (PVWM) and deep white matter (DWM), enlarged perivascular spaces (ePVS), lacunar strokes, and cerebral microbleeds (CMBs). RESULTS: PVWM hyperintensities were found in 46% of volunteers and was significantly lower (p = 0.027), corresponding to AS patients (80%), the density of lesions was higher in the AS group than in controls (p = 0.019). DWM hyperintensities were found more often in AS patients (76%) than in controls (66%) (p = 0.303), but the densities were similar in both groups. Lacunar strokes were found in 35% of AS patients and 16% of controls (p = 0.042). The average number of lacunar strokes per person was 0.9 in the AS group and 0.3 in the controls (p = 0.035). The AS group showed higher variance in the number of strokes: SD = 1.96 vs. SD = 1.06 in controls. Both prevalence and density of the ePVS and CMBs did not differ significantly between the groups. CONCLUSIONS: Neuroradiological indices of the vascular disease do not provide an unequivocal clue to the pathogenesis of CSVD in patients with severe AS. Most observations imply that CSVD is primarily a consequence of cerebral hypoperfusion caused by AS.

Diameters of Arteries Supplying Horseshoe Kidneys and the Level They Branch off Their Parental Vessels: A CT-Angiographic Study.

BACKGROUND: The most common renal fusion anomaly is horseshoe kidney (HSK), a condition associated with variable arterial blood supply. The aim of this study was to determine whether the height of origin of the renal artery determines its diameter and whether it differs from the mean diameter of the renal arteries of normal kidneys (NK). METHODS: Computer tomography angiography (CTA) studies of 336 patients (88 HSK and 248 NK) were obtained in a search of renal arteries; these were than classified into four groups according to height of its origin: Group I, branching from the aorta superior to the inferior mesenteric artery (IMA); Group II, branching from the aorta below the IMA; Group III, branching from the iliac artery; and Group IV, originating from the internal and external iliac artery. RESULTS: The HSK group included 398 arteries (mean diameter 4.30 mm) and the NK group 598 (5.52 mm) (p < 0.0001). In the HSK group, the mean diameters according to groups were: Group I, 4.54 mm; Group II, 4.28 mm; Group III, 3.41 mm; and Group IV, 3.43 mm. Statistically significant differences were found between arteries originating from the aorta and arteries branching from the iliac arteries (p < 0.0001). In the NK group, the corresponding values were: Group I, 5.53 mm; and Group II, 4.45 mm. The number of arteries supplying the HSK wider than 3.0 mm were: Group I, 83.0%; Group II, 82.4%; Group III, 68.4%; and Group IV, 66.6%. CONCLUSIONS: The renal arteries of the HSK branch from their parental vessels at lower levels and have smaller diameters than those of NK.