RESUMEN
Hypertension is a common problem; if left untreated, it can result in significant complications, including those involving the cardiovascular system and end organs. Approximately 10% of patients with hypertension are classified as having secondary hypertension, defined as hypertension attributable to a specific and potentially remediable cause. The evaluation for secondary hypertension typically begins with acquiring the patient history and performing a physical examination and screening laboratory tests. Directed imaging may be performed, on the basis of laboratory test results, to assess for potential causes of secondary hypertension. The causes can be broadly classified as endocrine (eg, hyperaldosteronism, pheochromocytoma, hyperparathyroidism) and nonendocrine (eg, aortic coarctation, renal vascular hypertension). In addition, patients with hypertension can develop significant complications that also are diagnosed with imaging, including conditions involving the cardiovascular system (eg, aortic aneurysm, acute aortic syndrome) and central nervous system (eg, stroke, subarachnoid hemorrhage, and posterior reversible encephalopathy syndrome). The imaging workup and imaging appearances of some of the causes of secondary hypertension are reviewed, treatment options are discussed, and the imaging appearances of hypertension-related complications are described. It is important for radiologists to accurately diagnose the secondary causes of hypertension, as many of them are treatable, and treatment may result in improved symptoms or resolution of hypertension. ©RSNA, 2019.
Asunto(s)
Hipertensión/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , Enfermedades de la Aorta/complicaciones , Enfermedades de la Aorta/diagnóstico por imagen , Trastornos Cerebrovasculares/diagnóstico por imagen , Trastornos Cerebrovasculares/etiología , Angiografía por Tomografía Computarizada/métodos , Neoplasias de las Glándulas Endocrinas/complicaciones , Neoplasias de las Glándulas Endocrinas/diagnóstico , Enfermedades del Sistema Endocrino/complicaciones , Enfermedades del Sistema Endocrino/diagnóstico , Humanos , Hipertensión/etiología , Hipertensión Renal/complicaciones , Hipertensión Renal/diagnóstico por imagen , Hipertensión Renovascular/complicaciones , Hipertensión Renovascular/diagnóstico por imagen , Isquemia Miocárdica/diagnóstico por imagen , Isquemia Miocárdica/etiología , NeuroimagenRESUMEN
BACKGROUND: The present study was undertaken to assess the resistive index (RI) of central retinal artery (CRA) as a bioimaging biomarker for the severity of diabetic retinopathy (DR), for the first time. METHODS: Eighty-one consecutive patients of type 2 diabetes mellitus between the ages of 40 and 70 years were included in a tertiary care center-based cross sectional study. Severity of retinopathy was assessed according to Early Treatment Diabetic Retinopathy Study (ETDRS) classification: diabetes mellitus with no retinopathy (No DR) (n = 26); non-proliferative diabetic retinopathy (NPDR) (n = 29); and proliferative diabetic retinopathy (PDR) (n = 26). Twenty-six healthy controls of similar age were also included. Resistive index of CRA was studied using color Doppler and gray scale sonography. Central subfield thickness (CST), cube average thickness (CAT), retinal photoreceptor ellipsoid zone (EZ) disruption, and retinal nerve fiber layer (RNFL) thickness were evaluated using spectral domain optical coherence tomography. Sensitivity and specificity were assessed by receiver operating characteristic (ROC) curve. RESULTS: Mean RI of CRA for the study groups revealed significant increase with severity of diabetic retinopathy (F = 10.24, P < 0.001). The ROC curve analysis showed diagnostic accuracy of RI of CRA (area under curve = 0.841-0.999; sensitivity = 76-100%, specificity = 95.45-100%, P < 0.001) in discriminating controls and patients. Univariate regression analysis revealed significant association between the study groups and RI of CRA (P < 0.001). RI of CRA correlated positively with CST (r = 0.37), CAT (r = 0.45), EZ disruption (r = 0.43) and negatively with RNFL thickness (r = - 0.35) (P < 0.001). CONCLUSIONS: Resistive index of CRA is a reliable bioimaging biomarker for the severity of DR.
RESUMEN
Magnetic resonance imaging features of benign liver schwannoma in a 52-year-old woman are described. An oval shaped, 4.4x3.6x2.9-cm lesion was located in Segment 7 of the right hepatic lobe. The lesion was hypointense on T(1)-weighted images and mixed hypo- and hyperintense on T(2)-weighted images. On serial contrast-enhanced images, the lesion revealed gradually increasing centrilobular enhancement. The tumor was surgically removed thereafter.
Asunto(s)
Neoplasias Hepáticas/patología , Imagen por Resonancia Magnética/métodos , Neurilemoma/patología , Biopsia , Medios de Contraste , Femenino , Gadolinio DTPA , Humanos , Neoplasias Hepáticas/cirugía , Persona de Mediana Edad , Neurilemoma/cirugíaRESUMEN
OBJECTIVE: To consider the clinical outcomes and restenosis rates of drug-eluting balloons (DEBs) and percutaneous transluminal angioplasty (PTA) in diabetic patients with infrapopliteal (IP) arterial disease. MATERIALS AND METHODS: This retrospective, single-center study included 51 patients (37 males; mean age: 63.43 ± 9.81 years) with diabetes mellitus having IP arterial disease, from October 2012 to September 2014. Twenty-two patients were treated with PTA, and 29 patients were treated with DEBs. After intervention, the patients were evaluated in the first week and every 3 months, clinically and radiologically. Univariate and multivariate analyses were used to evaluate the clinical outcomes of diabetic patients with IP arterial disease who were treated with either DEBs or PTA. RESULTS: There were no statistically significant differences between the groups in terms of age and gender, risk factors, characteristics of lesions, or the diameters or length of the balloons ( P > .05). Primary patency was higher in the DEB group than in the PTA group (97.8% vs 81.1%, P = .020) in the first 3 months. However, there was no statistically significant difference at 1-year follow-up (68.2% vs 48.5%, P = .131). At the 12-month follow-up, there was no difference in clinical improvement between the groups ( P = .193). CONCLUSION: The findings of this study reveal that DEB is a safe alternative treatment method for IP arterial disease in diabetic patients.
Asunto(s)
Angioplastia de Balón/instrumentación , Fármacos Cardiovasculares/administración & dosificación , Materiales Biocompatibles Revestidos , Angiopatías Diabéticas/terapia , Paclitaxel/administración & dosificación , Enfermedad Arterial Periférica/terapia , Arteria Poplítea , Dispositivos de Acceso Vascular , Anciano , Angioplastia de Balón/efectos adversos , Distribución de Chi-Cuadrado , Angiopatías Diabéticas/diagnóstico por imagen , Angiopatías Diabéticas/fisiopatología , Diseño de Equipo , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Arteria Poplítea/diagnóstico por imagen , Arteria Poplítea/fisiopatología , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Turquía , Grado de Desobstrucción VascularRESUMEN
OBJECTIVE: The aim of this study was to examine the association between right atrium (RA) and right ventricle (RV) diameters on computed tomography (CT) pulmonary angiography in response to acute pulmonary embolism (APE), in addition to 30-day mortality and adverse outcomes in patients with APE. METHODS: This retrospective study was accepted by the institutional ethics committee. From January 2013 to March 2014, 79 hospitalized adult patients with symptomatic APE were included. Inclusion criteria were a CT pulmonary angiography positive for pulmonary embolism, availability of patient records, and a follow-up of at least 30 days. A review of patient records and images was performed. The maximum diameters of the heart chambers were measured on a reconstructed four-chamber heart view, and the vascular obstruction index was calculated on CT pulmonary angiography. RESULTS: There were statistically significant relationships in both the RA/RV diameter ratio and the RV/left ventricle (LV) diameter ratio between patients with and without adverse outcomes (p<0.001 and 0.002, respectively). Furthermore, there was a statistically significant difference in the RA/RV diameter ratio, but not in the RV/LV diameter ratio, between those with and without 30-day mortality (p=0.002 and 0.148, respectively). CONCLUSIONS: Measurement of the RA/RV diameter ratio may be an alternative and useful method for predicting 30-day mortality and adverse outcome in patients with APE.