Thoracic Endovascular Aortic Repair Through Cardiac Apex in the Setting of Thoracic Aortic Rupture.

Treatment of thoracic aortic rupture poses a substantial challenge for the aortic surgeon. The advent of thoracic endovascular aortic repair (TEVAR) revolutionized the treatment of this heterogeneous group of diseases. Some patients suitable for TEVAR, however, present severe peripheral vascular diseases that can prevent standard retrograde delivery of the stent graft through the femoral artery. In this report, we present a case series of 5 patients with thoracic aortic rupture successfully treated with cardiac transapical TEVAR.

A wide skull ostelytic metastasis in advanced breast cancer.

BACKGROUND: We present a case report of a large and deep osteolytic metastasis radiological documented involving the skull in a woman affected by advanced breast cancer during endocrine therapy.

Coronary calcium score as gatekeeper for 64-slice computed tomography coronary angiography in patients with chest pain: per-segment and per-patient analysis.

We sought to investigate the performance of 64-slice CT in symptomatic patients with different coronary calcium scores. Two hundred patients undergoing 64-slice CT coronary angiography for suspected coronary artery disease were enrolled into five groups based on Agatston calcium score using the Mayo Clinic risk stratification: group 1: score 0, group 2: score 1-10, group 3: score 11-100, group 4: score 101-400, and group 5: score > 401. Diagnostic accuracy for the detection of significant (>/=50% lumen reduction) coronary artery stenosis was assessed on a per-segment and per-patient base using quantitative coronary angiography as the gold standard. For groups 1 through 5, sensitivity was 97, 96, 91, 90, 92%, and specificity was 99, 98, 96, 88, 90%, respectively, on a per-segment basis. On a per-patient basis, the best diagnostic performance was obtained in group 1 (sensitivity 100% and specificity 100%) and group 5 (sensitivity 95% and specificity 100%). Progressively higher coronary calcium levels affect diagnostic accuracy of CT coronary angiography, decreasing sensitivity and specificity on a per-segment base. On a per-patient base, the best results in terms of diagnostic accuracy were obtained in the populations with very low and very high cardiovascular risk.

Predictive value of chest CT in patients with cystic fibrosis: a single-center 10-year experience.

OBJECTIVE: The objective of our study was to assess the accuracy of one of the most used scoring systems, the Bhalla scoring system, in the detection of lung impairment in patients with cystic fibrosis and in the prediction of cystic fibrosis progression. MATERIALS AND METHODS: From the database of our center, 300 CT examinations performed between 1991 and 2001 were reviewed. Pulmonary function tests performed the same day as radiologic assessment were available. Of this group, 145 examinations were retrospectively included, referring to 87 patients with confirmed cystic fibrosis and a mean age (+/- SD) of 15.6 +/- 8.4 years (range, 9 months-38 years). Thirty patients underwent one CT examination, 56 underwent two examinations, and one patient underwent three examinations. The mean interval between two examinations was 36.5 months. The 145 examinations were independently reviewed by three radiologists who were blinded to the clinical and pulmonary function test results. The CT examinations were assessed using the scoring system proposed by Bhalla and colleagues. RESULTS: CT assessed using the Bhalla scoring system is mildly correlated with functional pulmonary test results and has high interobserver reproducibility. The CT score significantly changed between scans obtained in a mean interval of 36.5 months, whereas functional pulmonary test results did not, suggesting that CT is more sensitive than function tests for detecting small changes. However, the variation in CT scores did not predict progression of functional pulmonary test results or progression of CT findings between scans. CONCLUSION: CT assessment based on the Bhalla scoring system is more sensitive than pulmonary function tests in detecting initial morphologic changes. However, we found no evidence of the predictive value of CT.

Coronary plaque imaging with multislice computed tomography: technique and clinical applications.

The composition of an atherosclerotic lesion, rather than solely the degree of stenosis, is considered to be an important determinant of acute coronary events. Whereas until recently only invasive techniques have been able to provide clues about plaque composition with consistent reproducibility, several recent studies have revealed the potential of multislice computed tomography (MSCT) for noninvasive plaque imaging. Coronary MSCT has the potential to detect coronary plaques and to characterize their composition based on the X-ray attenuating features of each structure. MSCT may also reveal the total plaque burden (calcified and noncalcified components) for individual patients with coronary atherosclerosis. However, several parameters (i.e. lumen attenuation, convolution filtering, body mass index of the patient, and contrast to noise ratio of the images) are able to modify the attenuation values that are used to define the composition of coronary plaques. The detection of vulnerable plaques will require more sophisticated scanners combined with newer software applications able to provide quantitative information. The aim of this article is to discuss the potential benefits and limitations of MSCT in coronary plaque imaging.