Natural history of renal artery aneurysms.

OBJECTIVE: The existing renal artery aneurysm (RAA) literature is largely composed of reports of patients who underwent intervention. The objective of this study was to review the natural history of RAA. METHODS: This single-institution retrospective analysis studied all patients with RAA diagnosed by computed tomography imaging between 2015 and 2019, identified by our institutional radiology database. Imaging, demographic, and clinical data were obtained via the electronic medical record. He growth rate was calculated for all patients with radiological follow-up. RESULTS: The cohort consists of 331 patients with 338 RAAs. Most patients were female (61.3%), with 11 (3.3%) of childbearing age. The mean age at diagnosis was 71.5 years (range, 24-99 years). Medical comorbidities included hypertension (73.7%), prior smoking (34.4%), and connective tissue disease (3.9%). Imaging indications included abdominal pain (33.5%), unrelated follow-up (29.6%), and follow-up of an RAA initially diagnosed before the study period (10.7%). Right RAA (61.9%) was more common than left (35.1%); 3% of patients had bilateral RAA. The mean diameter at diagnosis was 12.9 ± 5.9 mm. Size distribution included lesions measuring less than <15 mm (69.9%), 15 to 25 mm (27.1%), and more than 25 mm (3.0%). Anatomic locations included the distal RA (26.7%), renal hilum (42.4%), and mid-RA (13.1%). The majority were true aneurysms (98%); of these, 72.3% were fusiform and 27.7% were saccular. Additional characteristics included calcification (82.2%), thrombus (15.9%), and dissection (0.9%). Associated findings included aortic atherosclerosis (65.6%), additional visceral aneurysms (7.3%), and abdominal aortic aneurysm (5.7%). The mean clinical follow-up among 281 patients was 41.0 ± 24.0 months. The mean radiological follow-up among 137 patients was 26.0 ± 21.4 months. Of these, 43 patients (31.4%) experienced growth, with mean growth rate of 0.23 ± 4.7 mm/year; the remainder remained stable in size. Eight patients eventually underwent intervention (5 endovascular), with the most common indications including size criteria (4/8) and symptom development (3/8). No patient developed rupture. On multivariate analysis, obesity (P = .04) was significantly associated with growth. An initial diameter of more than 25 mm was significantly associated with subsequent intervention (P = .006), but was not significantly associated with growth. Four of five RAAs with an initial diameter 30 mm or greater did not undergo intervention. The mean clinical follow-up for these patients was 24 months; none developed rupture and two remained stable in size. CONCLUSIONS: This large institutional cohort found that the majority of RAAs remained stable in size, with few patients meeting indications for repair based on societal guidelines. Current guidelines recommending intervention for asymptomatic aneurysms more than 30 mm seem to be appropriate given their slow progression.

Temporal processing as a source of altered visual perception in high autistic tendency.

Superior local at the expense of global perception characterises vision in autism spectrum disorders (ASD). However, progress towards discovering a neural mechanism has been slow. Here we used known differences in magnocellular and parvocellular receptive field properties to assess the temporal encoding of information, via flicker fusion paradigms, in those high and low in self-reported autistic tendency (Autism Spectrum Quotient - AQ). A Low AQ group (AQ≤13, n=22), and a High AQ group (AQ≥18, n=17) undertook a 4AFC luminance flicker fusion (FF) with 5 temporal contrasts from 5% to 100%, and a 2AFC isoluminant red-green colour fusion task. Both groups showed an increase in fusion thresholds with temporal achromatic contrast. The High AQ group displayed diminished flicker fusion thresholds compared to the Low AQ at the lowest contrasts. For the red-green colour fusion task, the High AQ group displayed mean fusion frequency slightly greater than the Low AQ group. A significant interaction between 5% luminance contrast and the red-green fusion frequencies demonstrated that the differences in thresholds were not simply due to variations in overall attentional capacity between groups. These differences in flicker fusion thresholds are in accordance with reported differences in cortical visual evoked potential nonlinearities, particularly relating to the neural efficiency of the magnocellular pathway.