Liver Fat Assessed With CT Relates to MRI Markers of Incipient Brain Injury in Middle-Aged to Elderly Overweight Persons.

OBJECTIVE: Obesity has been related to structural brain abnormalities. Increasing evidence suggests that accumulation of fat in the liver is an important determinant of cardiometabolic complications of obesity. The purpose of this study was to investigate the association between CT-assessed liver-to-spleen attenuation ratio as a measure of liver steatosis and MRI-assessed brain tissue integrity in middle-aged to elderly persons. SUBJECTS AND METHODS: CT and MRI were performed on 213 participants (114 women, 99 men; mean age, 65 ± 7 years). Brain tissue integrity was assessed by magnetization transfer imaging. Linear regression analysis was adjusted for age, sex, vascular risk factors, and total body fat estimated from bioelectrical impedance analysis. RESULTS: Seventy-nine participants had normal weight (body mass index [BMI], 18.5-24.9), and 134 were overweight (BMI ≥ 25). Significant interaction was found between liver-to-spleen ratio and BMI (p = 0.001). In the overweight group, liver fat was associated with reduced brain tissue integrity in both gray matter (standardized ß = 0.22; 95% CI, 0.07-0.36) and white matter (standardized ß = 0.31; 95% CI, 0.15-0.45). These associations were not found in the normal weight group (gray matter standardized ß = -0.08; 95% CI, -0.33 to 0.16; white matter standardized ß = -0.09; 95% CI, -0.36-0.14). CONCLUSION: The results indicate that liver fat assessed with CT relates to MRI markers of incipient brain injury in middle-aged to elderly overweight persons.

Association between changes in brain microstructure and cognition in older subjects at increased risk for vascular disease.

BACKGROUND: The purpose of this study is to investigate whether changes in brain microstructure, detected by magnetization transfer imaging, are associated with cognition in older subjects at increased risk for vascular disease. METHODS: One hundred ninety three nondemented subjects (105 men, mean age 77 ± 3 years) from the Prospective Study of Pravastatin in the Elderly at Risk were included. To assess cross-sectional associations between magnetization transfer ratio (MTR) peak height and cognitive test scores, general linear model multivariate analysis was performed. Models were adjusted for age, sex, education level, vascular risk factors, individual white matter lesion volume, and brain atrophy. A repeated measures general linear model was used to investigate whether MTR peak height relates to cognitive test performance at baseline and 3.3-year follow-up. RESULTS: Cross-sectionally, MTR peak height was associated with performance on the STROOP test (unstandardized ß = -0.27, p = 0.045), delayed Picture Word Learning (PWL) test (ß = 0.48, p = 0.007), and the Letter Digit Coding test (ß = 1.1, p = 0.006). Repeated measures general linear model analysis showed that individuals with low MTR peak height at baseline performed worse on the STROOP test compared to subjects with intermediate MTR peak height (mean time to complete the test at baseline and follow-up, lower versus middle tertile of MTR peak height: 61.6 versus 52.7 s, p = 0.019) or compared to subjects with high MTR peak height (p = 0.046). Similarly, low MTR peak height was associated with worse performance on the immediate (lower versus middle tertile, p = 0.023; lower versus higher tertile, p = 0.032) and delayed PWL test (lower versus middle, p = 0.004; lower versus higher, p = 0.012) at baseline and follow-up testing. CONCLUSIONS: MTR peak height is associated with cognitive function in older subjects at increased risk for vascular disease.

Genetically determined prospect to become long-lived is associated with less abdominal fat and in particular less abdominal visceral fat in men.

PURPOSE: familial longevity is marked by an exceptionally healthy metabolic profile and low prevalence of cardiometabolic disease observed already at middle age. We aim to investigate whether regional body fat distribution, which has previously shown to be associated with cardiometabolic risk, is different in offspring of long-lived siblings compared with controls. METHODS: our institutional review board approved the study, and all participants (n = 344, average age in years 65.6) gave written informed consent. Offspring (n = 175) of non-agenarian siblings were included. Their partners (n = 169) were enrolled as controls. For abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) measurements, a single-slice 8.0 mm computed tomography (CT) acquisition was planned at the level of the 5th lumbar vertebra. In addition, participants underwent prospectively electrocardiography-triggered unenhanced volumetric CT of the heart. Abdominal VAT and SAT areas (cm(2)) and epicardial adipose tissue (EAT) volumes (ml) were acquired by semi-automated segmentation techniques. Linear regression analysis was performed adjusting for cardiovascular risk factors. RESULTS: total abdominal fat areas were smaller in male offspring compared with controls (353.0 versus 382.9 cm(2), P = 0.022). The association between low abdominal VAT areas in male offspring (149.7 versus 167.0 cm(2) in controls, P = 0.043) attenuated after additional adjustment for diabetes (P = 0.078). Differences were not observed for females. EAT volumes were similar between offspring of long-lived siblings and controls. CONCLUSION: males who have genetically determined prospect to become long-lived have less abdominal fat and in particular less abdominal VAT compared with controls.

Abdominal Tuberculosis Complicated by Intestinal Perforation.

Although relatively rare, there is an increasing incidence of abdominal tuberculosis (TB) in the developed countries, with the peritoneum being the most common site of involvement. Manifestation of abdominal TB should be considered in patients with relevant clinical symptoms and risk factors, including a history of prior TB infection and residence in or travel to an area where tuberculosis is endemic. We report a case of intestinal tuberculosis with a complicated disease course after the completion of treatment. Persisting abdominal symptoms during or after treatment should raise suspicion of subclinical intestinal obstruction. Early clinical recognition and surgical treatment may avoid poor outcome due to intestinal perforation.

Caseous calcification of the mitral annulus assessed by multimodality imaging.

Physicians may not be familiar with caseous calcification of the mitral annulus. It can therefore easily be mistaken for other conditions including tumors. In the appropriate clinical context, by using multimodality imaging, a correct diagnosis can be made, and patient concern or even unnecessary surgery can be avoided.

An unusual cause of multiple incidental lung nodules.

Cystic or cavitating lung nodules may reflect an additional diagnostic challenge in benign metastasizing leiomyoma. Our case underlines the importance of combining clinical and radiological findings with specific pulmonary pathology consultation.

Aortic Arch Stiffness Is Associated With Incipient Brain Injury in Patients With Hypertension.

BACKGROUND: It has been shown that microstructural brain tissue damage can be detected in hypertension patients, while the underlying mechanisms are not fully understood. We aim to explore the association between diffusion tensor imaging (DTI) measures of brain injury and aortic arch pulse wave velocity (PWV) in hypertensive patients without clinically manifest cerebrovascular disease. METHODS: Sixty-six hypertension patients (30 men, mean age 46±14 years) were prospectively included. Aortic arch PWV was assessed using velocity-encoded magnetic resonance imaging (VE-MRI). Brain tissue integrity was assessed by using DTI. Multivariable linear regression analysis was performed to assess the association between aortic arch PWV and fractional anisotropy (FA), axial diffusivity (AxD), and radial diffusivity (RD). RESULTS: Increased aortic arch PWV was associated with decreased white matter FA (ß = -0.30, P = 0.018), increased gray matter AxD (ß = 0.28, P = 0.016), and increased gray and white matter RD (ß = 0.30, P = 0.008 and ß = 0.35, P = 0.003, respectively). These effects were independent of age, sex, body mass index, smoking, and white matter hyperintensity (WMH) volume. CONCLUSIONS: Aortic arch stiffness relates to incipient brain injury before overt brain abnormalities may become apparent in patients with hypertension.

Computed tomography evaluation of cardiac structure and function.

Computed tomography is a noninvasive imaging modality that can be used for the evaluation of cardiac structure and function. This review provides an overview of established and emerging applications of cardiac computed tomography, including evaluation of left and right ventricular function, ventricular morphology, native and prosthetic valves, and pulmonary and coronary vein anatomy.

Association of liver enzymes and computed tomography markers of liver steatosis with familial longevity.

OBJECTIVE: Familial longevity is marked by enhanced peripheral but not hepatic insulin sensitivity. The liver has a critical role in the pathogenesis of hepatic insulin resistance. Therefore we hypothesized that the extent of liver steatosis would be similar between offspring of long-lived siblings and control subjects. To test our hypothesis, we investigated the extent of liver steatosis in non-diabetic offspring of long-lived siblings and age-matched controls by measuring liver enzymes in plasma and liver fat by computed tomography (CT). RESEARCH DESIGN AND METHODS: We measured nonfasting alanine transaminase (ALT), aspartate aminotransferase (AST), and Υ-glutamyl transferase (GGT) in 1625 subjects (736 men, mean age 59.1 years) from the Leiden Longevity Study, comprising offspring of long-lived siblings and partners thereof. In a random subgroup, fasting serum samples (n = 230) were evaluated and CT was performed (n = 268) for assessment of liver-spleen (L/S) ratio and the prevalence of moderate-to-severe non-alcoholic fatty liver disease (NAFLD). Linear mixed model analysis was performed adjusting for age, gender, body mass index, smoking, use of alcohol and hepatotoxic medication, and correlation of sibling relationship. RESULTS: Offspring of long-lived siblings had higher nonfasting ALT levels as compared to control subjects (24.3 mmol/L versus 23.2 mmol/L, p = 0.03), while AST and GGT levels were similar between the two groups. All fasting liver enzyme levels were similar between the two groups. CT L/S ratio and prevalence of moderate-to-severe NAFLD was similar between groups (1.12 vs 1.14, p = 0.25 and 8% versus 8%, p = 0.91, respectively). CONCLUSIONS: Except for nonfasting levels of ALT, which were slightly higher in the offspring of long-lived siblings compared to controls, no differences were found between groups in the extent of liver steatosis, as assessed with liver biochemical tests and CT. Thus, our data indicate that the extent of liver steatosis is similar between offspring of long-lived siblings and control subjects.

Microstructural brain tissue damage in metabolic syndrome.

OBJECTIVE: We investigated the association between metabolic syndrome risk factors and brain tissue integrity, as assessed by magnetic resonance imaging. RESEARCH DESIGN AND METHODS: From the Leiden Longevity Study, which is a community-based study of long-lived subjects, their offspring, and partners thereof, 130 subjects (61 men; mean age 66 years) were included. A metabolic syndrome score was computed by summing the individual number of components according to the Adult Treatment Panel III criteria. We performed linear and logistic regression analysis and used standardized ß-values to assess the association between metabolic syndrome and brain macrostructure (brain volume and white matter lesion load, lacunar infarcts, and cerebral microbleeds) and microstructure (mean magnetization transfer ratio [MTR], MTR histogram peak height, fractional anisotropy, and mean diffusivity [MD]). Linear and stepwise regression analysis was performed to identify the individual contribution of one metabolic syndrome parameter adjusting for the four other parameters. Models were adjusted for age, sex, and relation to long-lived family. RESULTS: Brain macrostructure was not associated with metabolic syndrome. In contrast, metabolic syndrome was associated with decreased gray (ß = -0.3 P = 0.001) and white matter peak height (ß = -0.3, P = 0.002) and increased gray matter MD (ß = 0.2, P = 0.01, P = 0.01). Serum HDL cholesterol (ß = 0.22, P = 0.012), triglycerides (ß =-0.25, P = 0.002), BMI (ß =-0.2, P = 0.014), and diastolic blood pressure (ß = -0.17, P = 0.047, and ß = -0.23, P = 0.009, for gray and white matter, respectively) were independent factors in these changes in brain microstructure. CONCLUSIONS: In early manifest metabolic syndrome, brain tissue decline can be detected. Serum HDL cholesterol, triglycerides, BMI, and diastolic blood pressure were independent factors in brain tissue integrity.

Evolution of coronary computed tomography radiation dose reduction at a tertiary referral center.

PURPOSE: We aimed to assess the temporal change in radiation doses from coronary computed tomography angiography (CCTA) during a 6-year period. High CCTA radiation doses have been reduced by multiple technologies that, if used appropriately, can decrease exposures significantly. METHODS: A total of 1277 examinations performed from 2005 to 2010 were included. Univariate and multivariable regression analysis of patient- and scan-related variables was performed with estimated radiation dose as the main outcome measure. RESULTS: Median doses decreased by 74.8% (P<.001), from 13.1 millisieverts (mSv) (interquartile range 9.3-14.7) in period 1 to 3.3 mSv (1.8-6.7) in period 4. Factors associated with greatest dose reductions (P<.001) were all most frequently applied in period 4: axial-sequential acquisition (univariate: -8.0 mSv [-9.7 to -7.9]), high-pitch helical acquisition (univariate: -8.8 mSv [-9.3 to -7.9]), reduced tube voltage (100 vs 120 kV) (univariate: -6.4 mSv [-7.4 to -5.4]), and use of automatic exposure control (univariate: -5.3 mSv [-6.2 to -4.4]). CONCLUSIONS: CCTA radiation doses were reduced 74.8% through increasing use of dose-saving measures and evolving scanner technology.