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1.
Lancet ; 401(10390): 1798-1809, 2023 05 27.
Artículo en Inglés | MEDLINE | ID: mdl-37116524

RESUMEN

BACKGROUND: Chronic limb-threatening ischaemia is the severest manifestation of peripheral arterial disease and presents with ischaemic pain at rest or tissue loss (ulceration, gangrene, or both), or both. We compared the effectiveness of a vein bypass first with a best endovascular treatment first revascularisation strategy in terms of preventing major amputation and death in patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal, revascularisation procedure to restore limb perfusion. METHODS: Bypass versus Angioplasty for Severe Ischaemia of the Leg (BASIL)-2 was an open-label, pragmatic, multicentre, phase 3, randomised trial done at 41 vascular surgery units in the UK (n=39), Sweden (n=1), and Denmark (n=1). Eligible patients were those who presented to hospital-based vascular surgery units with chronic limb-threatening ischaemia due to atherosclerotic disease and who required an infra-popliteal, with or without an additional more proximal infra-inguinal, revascularisation procedure to restore limb perfusion. Participants were randomly assigned (1:1) to receive either vein bypass (vein bypass group) or best endovascular treatment (best endovascular treatment group) as their first revascularisation procedure through a secure online randomisation system. Participants were excluded if they had ischaemic pain or tissue loss considered not to be primarily due to atherosclerotic peripheral artery disease. Most vein bypasses used the great saphenous vein and originated from the common or superficial femoral arteries. Most endovascular interventions comprised plain balloon angioplasty with selective use of plain or drug eluting stents. Participants were followed up for a minimum of 2 years. Data were collected locally at participating centres. In England, Wales, and Sweden, centralised databases were used to collect information on amputations and deaths. Data were analysed centrally at the Birmingham Clinical Trials Unit. The primary outcome was amputation-free survival defined as time to first major (above the ankle) amputation or death from any cause measured in the intention-to-treat population. Safety was assessed by monitoring serious adverse events up to 30-days after first revascularisation. The trial is registered with the ISRCTN registry, ISRCTN27728689. FINDINGS: Between July 22, 2014, and Nov 30, 2020, 345 participants (65 [19%] women and 280 [81%] men; median age 72·5 years [62·7-79·3]) with chronic limb-threatening ischaemia were enrolled in the trial and randomly assigned: 172 (50%) to the vein bypass group and 173 (50%) to the best endovascular treatment group. Major amputation or death occurred in 108 (63%) of 172 patients in the vein bypass group and 92 (53%) of 173 patients in the best endovascular treatment group (adjusted hazard ratio [HR] 1·35 [95% CI 1·02-1·80]; p=0·037). 91 (53%) of 172 patients in the vein bypass group and 77 (45%) of 173 patients in the best endovascular treatment group died (adjusted HR 1·37 [95% CI 1·00-1·87]). In both groups the most common causes of morbidity and death, including that occurring within 30 days of their first revascularisation, were cardiovascular (61 deaths in the vein bypass group and 49 in the best endovascular treatment group) and respiratory events (25 deaths in the vein bypass group and 23 in the best endovascular treatment group; number of cardiovascular and respiratory deaths were not mutually exclusive). INTERPRETATION: In the BASIL-2 trial, a best endovascular treatment first revascularisation strategy was associated with a better amputation-free survival, which was largely driven by fewer deaths in the best endovascular treatment group. These data suggest that more patients with chronic limb-threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal, revascularisation procedure to restore limb perfusion should be considered for a best endovascular treatment first revascularisation strategy. FUNDING: UK National Institute of Health Research Health Technology Programme.


Asunto(s)
Angioplastia Coronaria con Balón , Ocimum basilicum , Enfermedad Arterial Periférica , Masculino , Humanos , Femenino , Anciano , Isquemia Crónica que Amenaza las Extremidades , Isquemia/cirugía , Enfermedad Arterial Periférica/complicaciones , Enfermedad Arterial Periférica/cirugía , Factores de Riesgo , Perfusión , Dolor , Resultado del Tratamiento
2.
Vasa ; 52(2): 97-106, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-36660828

RESUMEN

Background: Venous thromboembolism appears to be associated with severe COVID-19 infection than in those without it. However, this varies considerably depending on the cohort studied. The aims of this single-centre, multi-site retrospective cross-sectional study were to assess the number of all venous scans performed in the first month of pandemic in a large university teaching hospital, to evaluate the incidence of deep venous thrombosis (DVT), and assess the predictive ability of the clinical information available on the electronic patient record in planning work-up for DVT and prioritising ultrasound scans. Patients and methods: All consecutive patients undergoing venous ultrasound for suspected acute DVT between 1st of March and 30th of April 2020 were considered. Primary outcome was the proportion of scans positive for DVT; the secondary outcomes included association of a positive SARS-CoV-2 PCR test, demographic, clinical factors, and Wells scores. Results: 819 ultrasound scans were performed on 762 patients across the Trust in March and April 2020. This number was comparable to the corresponding pre-pandemic cohort from 2019. The overall prevalence of DVT in the studied cohort was 16.1% and was higher than before the pandemic (11.5%, p=.047). Clinical symptoms consistent with COVID-19, irrespective of the SARS-CoV-2 PCR test result (positive_COVID_PCR OR 4.97, 95%CI 2.31-10.62, p<.001; negative_COVID_PCR OR 1.97, 95%CI 1.12-3.39, p=.016), a history of AF (OR 0.20, 95%CI 0.03-0.73, p=.037), and personal history of venous thromboembolism (VTE) (OR 1.95, 95%CI 1.13-3.31, p=.014), were independently associated with the diagnosis of DVT on ultrasound scan. Wells score was not associated with the incidence of DVT. Conclusions: Amongst those referred for the DVT scan, SARS-CoV-2 PCR test was associated with an increased risk of VTE and should be taken into consideration when planning DVT work-up and prioritising diagnostic imaging. We postulate that the threshold for imaging should possibly be lower.


Asunto(s)
COVID-19 , Tromboembolia Venosa , Humanos , Tromboembolia Venosa/epidemiología , SARS-CoV-2 , COVID-19/epidemiología , Estudios Retrospectivos , Pandemias , Prevalencia , Estudios Transversales , Prueba de COVID-19
3.
Postgrad Med J ; 89(1049): 165-72, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23243151

RESUMEN

Clinicians working in any acute medical/surgical unit need an understanding of mesenteric ischaemia. Acute mesenteric ischaemia is a life-threatening vascular emergency associated with high morbidity and mortality. However, prompt diagnosis with the use of contrast-enhanced CT, more specifically CT angiography, has replaced catheter angiography as the new standard and is readily available in many emergency departments. Similarly, new hybrid open surgery endovascular treatment can minimise the surgical insult to these often critically ill elderly patients. Together, these changes can change the previously grim prognosis associated with this condition. By contrast, chronic mesenteric ischaemia (CMI) is an insidious disease and often a diagnosis of exclusion. However, it can cause a significant reduction in a patient's quality of life, due to 'mesenteric angina' and food avoidance, yet can potentially be treated simply and effectively. Recognition of the typical clinical history and imaging findings is key to making the diagnosis in a timely fashion. Radiology plays a significant role in the diagnosis and increasingly in the treatment of mesenteric ischaemia. Other clinicians should have a basic understanding of what radiology can and cannot offer. The advantages and limitations of commonly used imaging modalities-plain films, CT, MRI and ultrasound, are examined. The significance of findings, such as pneumatosis coli and portal gas are explained. Finally, the different endovascular management of both acute and CMI is discussed, which have emerged as minimally invasive options to complement open revascularisation surgery.


Asunto(s)
Isquemia/diagnóstico , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía/métodos , Enfermedades Vasculares/diagnóstico , Angiografía/métodos , Diagnóstico por Imagen/métodos , Humanos , Isquemia/diagnóstico por imagen , Isquemia/terapia , Isquemia Mesentérica , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/terapia
4.
Postgrad Med J ; 89(1049): 157-64, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23223775

RESUMEN

Deep venous thrombosis is a common life-threatening disorder with a significant mortality rate. The current standard anticoagulation therapy has proven inadequate in prevention of long-term post-thrombotic symptoms in patients with large clot burdens. Over the last two decades, advances in endovascular therapies have delivered a range of new treatment options including catheter-directed thrombolysis, percutaneous mechanical thrombectomy, venoplasty and stenting and inferior vena caval filter devices. Although there has been growing experience and guidelines in the treatment of deep vein thrombosis, there remains a wide variation in clinical practice nationally. This paper aims to raise the awareness of these emerging therapies and reviews the available evidence for their use.


Asunto(s)
Anticoagulantes/uso terapéutico , Radiología Intervencionista/métodos , Trombectomía/métodos , Terapia Trombolítica/métodos , Filtros de Vena Cava , Trombosis de la Vena/terapia , Humanos , Trombosis de la Vena/prevención & control
5.
AJR Am J Roentgenol ; 199(2): W175-86, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22826419

RESUMEN

OBJECTIVE: This article reviews the spectrum of disease processes that may involve the aortic root with particular emphasis on the role of cardiovascular MRI and MDCT angiography in their assessment. Key MRI and MDCT imaging findings are discussed and illustrated. CONCLUSION: Radiologists should be aware of the spectrum of disease processes that may involve the aortic root and their appearances at MRI and MDCT angiography.


Asunto(s)
Válvula Aórtica/patología , Enfermedades de las Válvulas Cardíacas/diagnóstico , Imagen por Resonancia Magnética/métodos , Seno Aórtico/patología , Tomografía Computarizada por Rayos X/métodos , Válvula Aórtica/anomalías , Angiografía Coronaria/métodos , Enfermedades de las Válvulas Cardíacas/congénito , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Humanos , Seno Aórtico/anomalías
6.
Postgrad Med J ; 88(1045): 661-7, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-22984184

RESUMEN

Intramural haematoma (IMH) is a localised haemorrhage within the aortic wall. Imaging plays a central role in diagnosing IMH, differentiating it from aortic dissection (AD) and assessing for complications. Imaging is also important for prognostication and to help guide clinical decision making as a number of imaging characteristics have been correlated with increased mortality rates including location, mural thickness and aortic diameter. Multidetector CT is the leading technique for diagnosis and classification of IMH owing to speed of image acquisition, multiplanar capabilities and excellent spatial resolution. MRI is rarely used to investigate the initial presentation of IMH but is frequently used for serial follow-up studies. The clinical outcome of IMH may be favourable, with spontaneous regression over time, or it may be complicated by pericardial tamponade, aortic regurgitation and development of AD. Early surgical management is the treatment of choice for patients with Stanford type A IMH whereas most patients with Stanford type B IMH have a good short-term outcome with aggressive control of hypertension. This article reviews the pathogenesis, clinical features and complications of IMH as well as the role of advanced imaging techniques in its evaluation.


Asunto(s)
Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/etiología , Ecocardiografía/métodos , Hematoma/diagnóstico , Hematoma/etiología , Tomografía Computarizada Multidetector/métodos , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética/métodos
7.
J Cardiothorac Surg ; 17(1): 87, 2022 Apr 27.
Artículo en Inglés | MEDLINE | ID: mdl-35477517

RESUMEN

BACKGROUND: Percutaneous vascular interventions are performed for the treatment of haemoptysis and involve embolization of bronchial arteries, pulmonary arteries and pulmonary arteriovenous malformations. There are isolated reports of embolization of pseudoaneurysms forming in the pulmonary vasculature. The migration of components of the coils used in the embolization of vascular pulmonary pathologies is rare. CASE PRESENTATION: A 46-year-old man presented to the emergency department with cough, haemoptysis, and expectoration of lengths of metal wire. He had an episode of coughing out a wire about a year prior to his admission to our hospital, which he attributed to be present in the can of coke he had consumed at that time and did not report it to the doctors. His past medical history was significant for stab injury to the right chest 17 years ago, for which he underwent right thoracotomy and exploration for bleeding. Injury to the lung parenchyma was noted and repair was performed by suturing the defect. Post operatively the CT scan demonstrated development of pulmonary artery pseudoaneurysm. We report a case of a patient expectorating coils 17 years after embolization of this traumatic pulmonary artery pseudoaneurysm. Radiological imaging demonstrated coils in the perihilar area of the lung parenchyma and in the tracheobronchial lumen. Operative intervention was used to remove the coils. CONCLUSIONS: Although percutaneous catheter based vascular interventions have emerged as safe and effective procedures, the long-term complications such as coil migration, recanalization and need for further embolization ought to be considered and patients need to be counselled and followed-up accordingly. To the best of our knowledge, this is the first case of migrated coil post embolization of post-traumatic pulmonary artery pseudoaneurysm. Ultimately, the management of endobronchial coil migration post embolization, be it surgical or bronchoscopic, should be decided on a case-by-case basis, considering the patient's symptoms and the risk fatal complications.


Asunto(s)
Aneurisma Falso , Embolización Terapéutica , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/terapia , Embolización Terapéutica/métodos , Hemoptisis/etiología , Humanos , Pulmón , Masculino , Persona de Mediana Edad , Arteria Pulmonar/anomalías , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/cirugía
8.
AJR Am J Roentgenol ; 197(1): 103-12, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-21701017

RESUMEN

OBJECTIVE: This article reviews the role of cardiovascular MRI in the diagnosis and characterization of the spectrum of infectious and inflammatory disorders of the heart. An imaging protocol is described, and typical MRI findings are discussed and illustrated. CONCLUSION: Radiologists should be aware of the spectrum of infectious and inflammatory conditions that can affect the heart and the role of MRI in conjunction with other imaging techniques in their assessment.


Asunto(s)
Aumento de la Imagen/métodos , Infecciones/patología , Imagen por Resonancia Cinemagnética/métodos , Miocarditis/diagnóstico , Miocardio/patología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad
9.
AJR Am J Roentgenol ; 195(6): 1444-8, 2010 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21098208

RESUMEN

OBJECTIVE: There is an increasing demand for MR angiography (MRA) techniques that do not require the administration of exogenous contrast material. Fresh blood imaging utilizes an ECG-gated fast spin-echo sequence to acquire images in both the systolic and diastolic phases of the cardiac cycle. Fast systolic arterial flow is differentiated from slower diastolic flow and a subtraction technique is used to produce angiographic images. We describe the technical aspects of performing lower extremity MRA and illustrate some sample cases. CONCLUSION: Fresh blood imaging is an emerging unenhanced MRA technique that has recently become commercially available. Early clinical trials appear promising and it is anticipated that fresh blood imaging will become invaluable, particularly in patients with impaired renal function. Technical refinements are still required to perfect this novel MR application, particularly for the assessment of distal calf and pedal vessels and for the evaluation of patients with arrhythmias and those with impaired cardiac function.


Asunto(s)
Arteriopatías Oclusivas/diagnóstico , Pierna/irrigación sanguínea , Angiografía por Resonancia Magnética/métodos , Enfermedades Vasculares Periféricas/diagnóstico , Adulto , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad
11.
Radiographics ; 27(2): 455-77, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-17374863

RESUMEN

Carcinoid tumors are a fascinating group of neuroendocrine neoplasms that develop either sporadically or as part of an inheritable syndrome. Many tumors arise in the bronchopulmonary or gastrointestinal tract, but a neuroendocrine tumor can arise in almost any organ. The tumors have varied malignant potential depending on the site of their origin, and the clinical manifestations often are nonspecific. Metastases may be present at the time of diagnosis, which often occurs at a late stage of the disease. Imaging plays a pivotal role in the localization and staging of neuroendocrine tumors and in monitoring the treatment response. Imaging is often challenging, and a combination of anatomic and functional techniques is usually required, depending on the tumor type and location. Techniques include ultrasonography, barium studies, endoscopy, computed tomography, magnetic resonance imaging, somatostatin receptor scintigraphy, iobenguane scintigraphy, and, in select cases, positron emission tomography. Coregistration of structural and functional images is often of incremental value for accurate localization of the primary tumor and any meta-static disease. Radiologists must understand the contribution of each imaging modality in the assessment of different neuroendocrine tumors. In addition, knowledge of the optimal technique for each radiologic and radionuclide imaging examination is essential. Familiarity with the protean imaging appearances of both primary and metastatic disease is essential for accurate staging, treatment monitoring, and surveillance. Finally, an understanding of the wide variety of treatment options for patients with carcinoid tumors is vital for optimal management.


Asunto(s)
Tumor Carcinoide/diagnóstico , Tumor Carcinoide/secundario , Diagnóstico por Imagen/métodos , Aumento de la Imagen/métodos , Humanos , Guías de Práctica Clínica como Asunto
12.
Clin Kidney J ; 10(6): 778-782, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29225807

RESUMEN

BACKGROUND: Chronic kidney disease (CKD) is the most common cause of secondary hypertension. More than half of the patients have uncontrolled hypertension (≥140/90 mmHg on three or more antihypertensive agents at optimum doses). Renal sympathetic denervation (RSDN) has been shown to reduce blood pressure (BP) in patients with resistant hypertension. Although patients with CKD have high sympathetic drive, all major clinical trials have excluded patients with estimated glomerular filtration rates (eGFRs) <45 mL/min/1.73m2 for risk of contrast-induced nephropathy. METHODS: In this pilot study, carbon dioxide (CO2) was used as the sole contrast agent to carry out renal angiography and RSDN in patients with moderate to severe CKD (eGFR 15-44 mL/min/1.73m2) and uncontrolled hypertension. RESULTS: Eleven patients (eight males) underwent RSDN. The median age was 57 years [interquartile range (IQR) 49-66]. The median number of antihypertensives being taken at baseline was 4 (IQR 3-4). No statistically significant difference was observed in serum creatinine in the serial follow-ups until at 6 months[median difference 0.25 mg/dL (IQR 0.09-0.53); P = 0.008]. There was a non-significant reduction in median clinic BP from baseline to 6 months [-14 mmHg (IQR -24-5)] and a significant increase in daytime ambulatory systolic BP [7 mmHg (IQR -2-12); P= 0.045]. A trend towards a serial reduction in albuminuria was observed. Procedure-related complications included a groin haematoma (n = 1) and reported flank (n = 1) and groin pain (n = 1). CONCLUSIONS: This pilot study shows that CO2 renal angiography can be used to perform RSDN in patients with significant renal impairment and may lead to associated improvements in clinic BP and albuminuria.

13.
Eur J Intern Med ; 17(5): 355-9, 2006 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-16864012

RESUMEN

INTRODUCTION: Oxygen is one of the most common drugs used in secondary care. It is often used incorrectly on hospital wards, and it has been suggested that prescribing oxygen would facilitate correct administration. However, the knowledge of hospital doctors who would prescribe oxygen, and that of nurses who administer it, has not been tested. METHODS: A questionnaire was prepared to test a person's knowledge of oxygen delivery devices and their use in different clinical scenarios. This questionnaire was given to 30 junior doctors and 53 nurses working on an acute medical ward in a district general hospital. RESULTS: The majority of doctors and nurses could not identify less commonly used oxygen delivery devices, such as a non-rebreathing mask with reservoir bag. A quarter of the doctors and nearly half the nurses were unable to select the correct dose and method of administration of oxygen in the event of cardiorespiratory arrest. The majority prescribed oxygen wrongly in the various clinical scenarios that dealt with respiratory failure. CONCLUSION: Junior doctors and nurses do not have sufficient knowledge and understanding of oxygen therapy to be able to prescribe the drug appropriately and safely.

14.
Br J Radiol ; 89(1062): 20150723, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26987373

RESUMEN

OBJECTIVE: Many major vascular centres, including ours, incorporate coverage of the thoracic aorta in CT scans evaluating abdominal aortic aneurysms (AAAs) (extended coverage contrast-enhanced CT (EC-CECT) scan]. We sought to determine the prevalence of thoracic pathology in a large consecutive series of patients with AAA undergoing EC-CECT. METHODS: All patients who underwent EC-CECT for AAA between April 2013 and 2014 were identified from our radiology information system. Reports were retrospectively reviewed and for each study, sex, age and reported thoracic aortic and other non-vascular findings were extracted. Findings were initially categorized into "major" or "minor" depending on if they were mentioned in the report impression/conclusion. Any major thoracic pathology was termed "significant" if there was a new diagnosis/patient intervention/investigation and a change in patient management. RESULTS: Of the 150 scans included in the study, 97 (65%) had at least one thoracic finding. These findings included 24 scans (16%) with major findings and 73 scans (48%) with minor findings. In 13 scans (9%), the findings were significant and resulted in a delay (n = 11) or cancellation (n = 2) of AAA repair. CONCLUSION: Pre-procedural EC-CECT helps to identify significant intrathoracic findings in patients with AAA, which can have a major impact on AAA repair. This study supports the routine use of pre-procedural EC-CECT in planning AAA repair. ADVANCES IN KNOWLEDGE: This study describes the prevalence of significant thoracic pathology, which can impact on AAA repair. This information could potentially change the pre-procedure imaging protocol for patients with AAA.


Asunto(s)
Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/epidemiología , Aortografía/estadística & datos numéricos , Angiografía por Tomografía Computarizada/estadística & datos numéricos , Radiografía Torácica/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Aortografía/métodos , Angiografía por Tomografía Computarizada/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Intensificación de Imagen Radiográfica/métodos , Radiografía Torácica/métodos , Reproducibilidad de los Resultados , Medición de Riesgo/métodos , Sensibilidad y Especificidad , Reino Unido/epidemiología
15.
Br J Radiol ; 89(1068): 20160311, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27653990

RESUMEN

OBJECTIVE: Hypertension is the leading attributable cause of cardiovascular mortality worldwide. Patients with hypertension have multiple comorbidities including high rates of concomitant renal disease. Current pharmacological approaches are inadequate in the treatment of resistant hypertension. Renal sympathetic denervation (RDN) has been shown to effectively treat resistant hypertension. The traditional use of iodinated contrast in RDN is contraindicated in patients with significant renal insufficiency. In patients with renal impairment, carbon dioxide (CO2) can be used as an alternative contrast material for RDN. This article describes the technical aspects of RDN using CO2 angiography. METHODS: Our centre is experienced in the innovative RDN procedure using CO2 angiography. We describe the protocol for CO2 angiography for RDN using a home-made CO2 delivery system and the Symplicity™ (Minneapolis MN 55432 USA) catheter (Medtronic) device. RESULTS: CO2 angiography is an excellent alternative to iodinated contrast for RDN procedures. CONCLUSION: CO2 angiography for RDN is a safe and effective alternative to iodinated contrast. RDN using CO2 angiography is an easy and feasible procedure that can be used in patients with renal insufficiency or iodinated contrast allergies. Advances in knowledge: There is a paucity of descriptive reports for CO2 angiography for RDN and we provide details of the optimal protocol for the procedure. In particular, we describe the use of a Symplicity Spyral™ catheter (Medtronic), which has not been reported to date for use in this procedure.


Asunto(s)
Angiografía/métodos , Dióxido de Carbono , Medios de Contraste , Aumento de la Imagen/métodos , Radiografía Intervencional/métodos , Simpatectomía , Humanos , Riñón
16.
Quant Imaging Med Surg ; 5(3): 423-32, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26029645

RESUMEN

Pulmonary arterial hypertension (PAH) may be suspected based on the clinical history, physical examination and electrocardiogram findings but imaging is usually central to confirming the diagnosis, establishing a cause and guiding therapy. The diagnostic pathway of PAH involves a variety of complimentary investigations of which computed tomography pulmonary angiography (CTPA) has established a central role both in helping identify an underlying cause for PAH and assessing resulting functional compromise. In particular CTPA is considered as the gold standard technique for the diagnosis of thromboembolic disease. This article reviews the CTPA evaluation in PAH, describing CTPA techniques, a systematic approach to interpretation and spectrum of key imaging findings.

17.
Quant Imaging Med Surg ; 4(4): 265-72, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25202662

RESUMEN

The aortic valve and adjacent structures should be routinely evaluated on all thoracic cross-sectional imaging studies. Echocardiography and magnetic resonance imaging (MRI) are the main imaging techniques used for assessment of the aortic valve and related pathology but multi-detector computed tomography (MDCT) can offer valuable complimentary information in some clinical scenarios. Radiologists should be familiar with the indications, advantages and limitations of MDCT for assessment of the aortic valve. This article reviews aortic valve anatomy and relevant terminology, technical aspects of MDCT image optimisation and describes a suggested approach to interpretation.

18.
Quant Imaging Med Surg ; 4(4): 273-81, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25202663

RESUMEN

The aortic valve and adjacent structures should be routinely evaluated on all thoracic cross-sectional imaging studies. Echocardiography and magnetic resonance imaging (MRI) are the main imaging techniques used for assessment of the aortic valve and related pathology but multi-detector computed tomography (MDCT) can offer valuable complimentary information in some clinical scenarios. MDCT is the definite means of assessing aortic valvular calcification, acute aortic syndrome and for non-invasive assessment of the coronary arteries. MDCT also has an emerging role in the planning and follow-up of trans-catheter aortic valve replacement. This article reviews the spectrum of aortic valve disease highlighting the key MDCT imaging features.

19.
Quant Imaging Med Surg ; 4(5): 300-6, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25392817

RESUMEN

PURPOSE: Accurate and reproducible measurement of aortic root dimensions is essential to inform clinical decision making. Transthoracic echocardiography (TTE) is the first line test for assessment of the aortic root but has potential limitations due to its limited field of view and restricted acoustic windows. Cardiac magnetic resonance imaging (MRI) is considered the "gold standard" technique for assessment of cardiac morphology and recently MRI reference ranges for aortic root dimensions have been published. The purpose of this study was to retrospectively compare aortic root measurements obtained from TTE with those derived from cardiac MRI. MATERIALS AND METHODS: Sixty-eight patients (40 males, 28 females) who had undergone both cardiac MRI and TTE imaging within a 4-month interval (mean 62 days) were included. Steady-state-free precession MRI cine imaging was performed with an acquisition plane perpendicular to the aortic root and through the true cross sectional aortic valve plane. A cusp-commissure dimension from inside wall to inside wall in end-diastole was recorded and compared with standardized TTE derived Valsalva sinus measurements. Pearson correlation coefficients and a paired t-test were used for statistical analysis. RESULTS: Mean aortic root dimension by TTE was 3.2±0.5 cm and MRI was 3.4±0.4 cm with a Pearson correlation coefficient of >0.7. Mean difference between TTE and MRI was 0.2±0.3 (P<0.001) with MRI producing a consistently higher measure. In four patients with a dilated aortic root by MRI the TTE measurement was within the normal reference range. In patients with a dilated aortic root (n=19) the mean difference was 0.2±0.4 cm (P<0.05) with MRI consistently producing the larger measure. In patients with a non-dilated aortic root t (n=49) the mean difference was 0.2±0.3 cm (P<0.05) with MRI consistently producing the larger measure. CONCLUSIONS: There is a high level of correlation between TTE and MRI derived aortic root measurements at the Valsalva sinus level. MRI consistently measures the aortic root dimension higher than TTE which may under diagnose patients with a mildly dilated aortic root. Further investigation is required to properly integrate MRI into imaging assessment algorithms.

20.
Quant Imaging Med Surg ; 4(5): 397-406, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25392824

RESUMEN

Hypertrophic cardiomyopathy (HCM) is the most common inheritable cardiac disorder, with an estimated prevalence of 1:500 in the general population. Most cases of HCM are phenotypically expressed in adolescence or early adulthood but age-related penetrance with certain phenotypes is increasingly recognized. Clinical manifestations of HCM are usually the result of systolic and/or diastolic dysfunction, left ventricular outflow tract (LVOT) obstruction, arrhythmias and sudden cardiac death (SCD). In recent years magnetic resonance imaging (MRI) has become established as an important tool for the evaluation of suspected HCM as it can reliably establish the diagnosis, help distinguish HCM from other causes of left ventricular hypertrophy (LVH) and identify those patients at greatest risk of SCD. This article reviews the current status of MRI in the evaluation of the HCM patient including imaging protocols, disease characterization and the emerging role of MRI for risk stratification and proband screening.

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