Relationship between left atrial dimensions and global and regional fat depots.

Background and Objectives: The relationship between body fat depots and the left atrial (LA) dimensions has not been fully explored. Our objective is to determine if there is a relationship not only with total body fat depots, but specifically with regional fatty depots. Materials and Methods: It was an observational, retrospective study that included consecutive patients referred to our institution with an order to perform computed tomography angiography triggered by electrocardiogram for different clinical indications. Measurements of the LA were made in the systolic phase, using four and two cameras views. Results: A total of 87 patients were included. The mean age was 66.4 ± 12.5 years; 67% were men. The LA volume indexed by the body surface area was 48.0 ± 16.6 cm3/m2. We identified significant correlations between the LA dimensions and the age (p < 0.05). However, no significant correlations were found between the LA dimensions and the body fat depots, either total or regional. Conclusions: In this study, we did not identify significant relationships between LA dimensions and global or regional body fat depots.

Antecedentes y objetivos: La relación entre los depósitos de grasa corporal y las dimensiones de la aurícula izquierda (AI) no ha sido del todo explorada. Nuestro objetivo es determinar si existe relación no solo con los depósitos de grasa corporal totales, sino específicamente con los depósitos grasos regionales. Materiales y métodos: Estudio observacional, retrospectivo, que incluyó pacientes consecutivos remitidos a nuestra institución con orden de realización de angiotomografía computarizada toracoabdominal gatillada con electrocardiograma por distintas indicaciones clínicas. Las mediciones de la AI se realizaron en la fase sistólica, utilizando vistas de cuatro y dos cámaras. Resultados: Se incluyeron un total de 87 pacientes. La edad media fue de 66.4 ± 12.5 años; un 67% de los sujetos fueron hombres. El volumen de la AI indexado por la superficie corporal fue de 48.0 ± 16.6 cm3/m2. Identificamos correlaciones significativas entre las dimensiones de la AI y la edad (p < 0.05). Sin embargo, no se evidenciaron correlaciones significativas entre las dimensiones de la AI y los distintos depósitos de grasa corporal, ya sea totales o regionales. Conclusiones: En este estudio, no identificamos relaciones significativas entre las dimensiones de la AI y los depósitos de grasa corporal globales o regionales.

Relationship between left atrial dimensions and global and regional fat depots.

Background and Objectives: The relationship between body fat depots and the left atrial (LA) dimensions has not been fully explored. Our objective is to determine if there is a relationship not only with total body fat depots, but specifically with regional fatty depots. Materials and Methods: It was an observational, retrospective study that included consecutive patients referred to our institution with an order to perform computed tomography angiography triggered by electrocardiogram for different clinical indications. Measurements of the LA were made in the systolic phase, using four and two cameras views. Results: A total of 87 patients were included. The mean age was 66.4 ± 12.5 years; 67% were men. The LA volume indexed by the body surface area was 48.0 ± 16.6 cm3/m2. We identified significant correlations between the LA dimensions and the age (p < 0.05). However, no significant correlations were found between the LA dimensions and the body fat depots, either total or regional. Conclusions: In this study, we did not identify significant relationships between LA dimensions and global or regional body fat depots.

Antecedentes y objetivos: La relación entre los depósitos de grasa corporal y las dimensiones de la aurícula izquierda (AI) no ha sido del todo explorada. Nuestro objetivo es determinar si existe relación no solo con los depósitos de grasa corporal totales, sino específicamente con los depósitos grasos regionales. Materiales y métodos: Estudio observacional, retrospectivo, que incluyó pacientes consecutivos remitidos a nuestra institución con orden de realización de angiotomografía computarizada toracoabdominal gatillada con electrocardiograma por distintas indicaciones clínicas. Las mediciones de la AI se realizaron en la fase sistólica, utilizando vistas de cuatro y dos cámaras. Resultados: Se incluyeron un total de 87 pacientes. La edad media fue de 66.4 ± 12.5 años; un 67% de los sujetos fueron hombres. El volumen de la AI indexado por la superficie corporal fue de 48.0 ± 16.6 cm3/m2. Identificamos correlaciones significativas entre las dimensiones de la AI y la edad (p < 0.05). Sin embargo, no se evidenciaron correlaciones significativas entre las dimensiones de la AI y los distintos depósitos de grasa corporal, ya sea totales o regionales. Conclusiones: En este estudio, no identificamos relaciones significativas entre las dimensiones de la AI y los depósitos de grasa corporal globales o regionales.

Relación entre las dimensiones de la aurícula izquierda y los depósitos globales y regionales de grasa corporal / Relationship between left atrial dimensions and global and regional fat depots

Resumen Antecedentes y objetivos: La relación entre los depósitos de grasa corporal y las dimensiones de la aurícula izquierda (AI) no ha sido del todo explorada. Nuestro objetivo es determinar si existe relación no solo con los depósitos de grasa corporal totales, sino específicamente con los depósitos grasos regionales. Materiales y métodos: Estudio observacional, retrospectivo, que incluyó pacientes consecutivos remitidos a nuestra institución con orden de realización de angiotomografía computarizada toracoabdominal gatillada con electrocardiograma por distintas indicaciones clínicas. Las mediciones de la AI se realizaron en la fase sistólica, utilizando vistas de cuatro y dos cámaras. Resultados: Se incluyeron un total de 87 pacientes. La edad media fue de 66.4 ± 12.5 años; un 67% de los sujetos fueron hombres. El volumen de la AI indexado por la superficie corporal fue de 48.0 ± 16.6 cm3/m2. Identificamos correlaciones significativas entre las dimensiones de la AI y la edad (p < 0.05). Sin embargo, no se evidenciaron correlaciones significativas entre las dimensiones de la AI y los distintos depósitos de grasa corporal, ya sea totales o regionales. Conclusiones: En este estudio, no identificamos relaciones significativas entre las dimensiones de la AI y los depósitos de grasa corporal globales o regionales.

Abstract Background and Objectives: The relationship between body fat depots and the left atrial (LA) dimensions has not been fully explored. Our objective is to determine if there is a relationship not only with total body fat depots, but specifically with regional fatty depots. Materials and Methods: It was an observational, retrospective study that included consecutive patients referred to our institution with an order to perform computed tomography angiography triggered by electrocardiogram for different clinical indications. Measurements of the LA were made in the systolic phase, using four and two cameras views. Results: A total of 87 patients were included. The mean age was 66.4 ± 12.5 years; 67% were men. The LA volume indexed by the body surface area was 48.0 ± 16.6 cm3/m2. We identified significant correlations between the LA dimensions and the age (p < 0.05). However, no significant correlations were found between the LA dimensions and the body fat depots, either total or regional. Conclusions: In this study, we did not identify significant relationships between LA dimensions and global or regional body fat depots.

Atherosclerotic plaque burden evaluated from neck to groin: effect of gender and cardiovascular risk factors.

We explored the impact of gender and cardiovascular risk factors (RF) in the distribution and burden of coronary and extra-coronary atherosclerotic plaques among patients undergoing ECG-gated thoracoabdominal computed tomography angiography (CTA) from the supra-aortic trunks to the femoral arteries. We included a consecutive cohort of patients who underwent ECG-gated thoracoabdominal aortic CTA from the supra-aortic trunks to the pubic symphysis. We evaluated the number of coronary segments with plaques [segment-involvement score (SIS)]; and the extra-coronary atherosclerotic plaque burden, comprising the aorta and supra-aortic trunks, iliofemoral arteries, and visceral arteries (extra-coronary SS). A total of 3400 vascular segments were evaluated in 100 patients (mean age 67.0 ± 12.6 years, 66% male). Seventy-two (72%) patients had evidence of atherosclerosis in the coronary tree (coronary SIS ≥ 1), of which 32% was extensive (coronary SIS > 5). Males had a significantly higher prevalence of coronary SIS ≥ 1 [53 (80%), vs. 19 (56%), p = 0.018], and coronary SIS > 5 [24 (36%) vs. 8 (24%), p = 0.035] than females. Extra-coronary SS was similar between genders (males 10.2 ± 5.8 vs. females 9.7 ± 5.4, p = 0.70), irrespective of the location along the different vascular beds. The number of coronary RF was significantly related to the coronary SIS (p = 0.038), and hypertension and diabetes were consistently related to coronary and extra-coronary plaque burden. In the present study involving analysis of multiple vascular beds from the supra-aortic trunks to the femoral arteries, we identified significant sex-related differences in coronary plaque burden, whereas extra-coronary plaque burden was similar between genders irrespective of the vascular bed assessed.

Prognostic Value of Vascular Calcifications and Regional Fat Depots Derived From Conventional Chest Computed Tomography.

PURPOSE: The prognostic value of vascular calcifications as well as of regional fat depots has been reported separately, in population-based studies, and using gated-computed tomography (CT) examinations. We, therefore, explored the interplay and prognostic value of vascular calcifications and adipose tissue depots assessed during conventional nongated chest CT. MATERIALS AND METHODS: We enrolled a consecutive series of 1250 patients aged between 35 and 74 years who underwent clinically indicated chest CT scans. We measured the extent of coronary artery calcification (CAC) using the segment-involvement score (CACSIS), and aortic and valve calcification. Pericardial fat volume (PFV), hepatic fat, and abdominal subcutaneous adipose tissue were also calculated. Patients were followed-up for all-cause mortality. RESULTS: A total of 577 (46%) patients had presence of CAC in the coronary tree. Over a mean follow-up of 3.7 years, 51 (4%) deaths occurred, 23 (4.1%) in male patients and 28 (4.1%) in female patients. Patients with higher PFV were older (P<0.0001), more frequently male (P<0.0001), had higher abdominal subcutaneous adipose tissue (P<0.0001), hepatic fat (P<0.0001), as well as a larger extent of CAC (P<0.0001), aortic calcium (P<0.0001), and valve calcium (P<0.0001). From a multivariable Cox regression model, age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.03-1.11), P=0.001, PFV upper tertile (HR, 4.07; 95% CI, 2.09-7.92), P<0.0001, and CACSIS>5 (HR, 2.19; 95% CI, 1.14-4.23; P<0.0001) were independent predictors of all-cause death. CONCLUSIONS: In this relatively large patient cohort undergoing clinically indicated conventional chest CT scans, PFV and coronary calcification were high-risk markers associated with worsening survival.

Pericardial and visceral, but not total body fat, are related to global coronary and extra-coronary atherosclerotic plaque burden.

BACKGROUND: To explore the relationship between coronary and extra-coronary atherosclerotic plaque burden with total and regional fat depots among patients undergoing ECG-gated aortic computed tomography angiography (CTA). METHODS: The subjects of this study comprised a cohort of consecutive patients who underwent ECG-gated thoracoabdominal CTA. We assessed the number of coronary segments with plaques (segment-involvement score, SIS); and the extra-coronary atherosclerotic plaque burden, comprising the aorta and supra-aortic trunks, iliofemoral arteries, and visceral arteries (extra-coronary SS). Total and regional fat volume (FV) were calculated. RESULTS: A total of 2700 vascular segments were evaluated in 90 patients. Obese patients (n = 31, 34%) showed similar coronary SIS (p = 0.41) and extra-coronary SS (p = 0.22) than non-obese patients. General body fat measurements were not related to atherosclerotic plaque burden scores, without associations between coronary or extra-coronary plaque burden and BMI (p = 0.68, and p = 0.91), abdominal circumference (p = 0.13, p = 0.89), total body FV (p = 0.50, p = 0.98), or abdominal FV (p = 0.51, p = 0.99). Pericardial FV was related to coronary SIS (p < 0.0001) and extra-coronary SS (p = 0.008), and visceral FV was related to the coronary SIS (p = 0.006) and extra-coronary SS (p = 0.056). Abdominal subcutaneous fat was inversely related to coronary SIS (p = 0.038) and extra-coronary SS (p = 0.010). Pericardial FV was identified as the only independent predictor of extensive coronary [OR 1.020 (95% CI 1.001-1.039), p = 0.036] and extra-coronary [OR 1.018 (95% CI 1.001-1.036), p = 0.035] plaque burden. CONCLUSIONS: In the present study, pericardial and visceral fat were associated with an increased atherosclerotic burden, whereas we identified an inverse relationship between subcutaneous abdominal fat and plaque burden.

Impact on mortality of coronary and non-coronary cardiovascular findings in non-gated thoracic CT by malignancy status.

PURPOSE: The prognostic value of coronary artery calcification (CAC) assessed on non-gated thoracic CT scans has only been explored in population-based studies. We explored the impact of the presence and extension of CAC, as well as of non-coronary atherosclerosis cardiovascular findings (NCACVF) in survival of patients with and without malignancies undergoing clinically indicated non-gated thoracic computed tomography (CT) scans. MATERIALS AND METHODS: Between August and December 2012, a total of 1.901 patients aged between 35 and 74 years underwent clinically indicated non-gated, non-enhanced thoracic CT scans and followed for mortality through September 2016. RESULTS: Three hundred and thirty two (17.5%), 250 (13.2%), and 329 (17.3%) patients showed CAC in 1, 2, and 3 vessels, respectively, and the remaining had no CAC. Two hundred and fifty five (13.4%) patients had evidence of extensive calcification (CACSIS>5). Only 62 (3.3%) had major NCACVF whereas 1635 (86%) had none or minimal NCACVF. After a median follow-up of 3.7 (3.5-3.9) years, 217 (11.4%) deaths occurred. Age [HR 1.03 (95% CI 1.01-1.05), p=0.001], a history of malignancy [HR 8.04 (95% CI 5.95-10.9), p<0.0001], and the NCACVF class [HR 1.79 (95% CI 1.45-2.19), p<0.0001] were identified as independent predictors of death. CACSIS was found an independent predictor of death only among patients without malignancy (HR 1.10 (95% CI 1.02-1.20), p=0.019). CONCLUSIONS: In this study including clinically indicated non-gated standard thoracic CT scans, survival rates were associated to the CAC extension among patients without malignancy, and to the NCACVF class independent from the malignancy status.

Spectral Signal Density of Carotid Plaque Using Dual-Energy Computed Tomography.

BACKGROUND AND PURPOSE: Plaque characterization using virtual monochromatic imaging derived from dual-energy computed tomography (CT) angiography requires the determination of normal signal density values of each plaque component. We sought to explore the signal density values of carotid plaque components using dual-energy compared to conventional single-energy CT angiography (CTA), and to establish the energy level with the largest differences between plaque components. METHODS: The present prospective study involved consecutive patients referred for carotid artery evaluation by CTA. Two scans (single-energy and dual-energy CTA) were performed in all patients, and a single radiologist analyzed the data. Single-source dual-energy CTA allowed the generation of virtual monochromatic images from 40 to 140 keV. RESULTS: A total of 35 internal carotid artery lesions were examined in 20 symptomatic patients. The mean age was 72.3 ± 6.7 years, and 9 (45%) patients were male. Internal carotid artery geometrical variables including lumen area (P = .96), vessel area (P = .97), and percent area stenosis (P = .99) did not differ between groups (single-energy CTA, and dual-energy CTA at 40, 70, 100, and 140 keV). Differences between signal densities of different tissues were largest at 40 keV (calcium/lumen, P < .0001; fat/noncalcified, P < .0001). CONCLUSIONS: In the present pilot investigation, virtual monochromatic imaging at low-energy levels derived from dual-energy CTA allowed the largest differences in attenuation levels between tissues, without affecting vessel or plaque geometry.

Tomografía computarizada de doble energía: nueva tecnología para la reducción de artefactos de metal / Dual-energy computed tomography: new technology for metal artifacts reduction

Introducción: El objetivo fue explorar la utilidad de la tomografía computarizada de doble energía mediante tecnología de imágenes espectrales gemstone y de un programa destinado a la reducción de artefactos de metal (MARS), para evaluar tejidos periprotésicos, y la interpretabilidad diagnóstica de patologías relacionadas con implantes. Materiales y Métodos: Se comparó la densidad ósea, de partes blandas y de grasa en el tejido periprotésico y en tejido de control sin implante, utilizando un escáner de alta definición de tomografía computarizada de doble energía tanto en imágenes policromáticas convencionales, como en monocromáticas virtuales con MARS, en 80 pacientes con prótesis metálicas en diversas regiones musculoesqueléticas. Se valoró la calidad de imagen y la interpretabilidad diagnóstica mediante la escala de Likert. Resultados: Con imágenes policromáticas hubo diferencias significativas entre el área periprotésica en los tres tejidos respecto a los controles (p <0,0001); sin diferencias significativas utilizando imágenes espectrales monocromáticas virtuales-MARS (hueso p = 0,053, partes blandas p = 0,32 y grasa p = 0,13), con más similitud con el tejido normal. Los niveles de ruido fueron significativamente mayores con imágenes policromáticas (p <0,0001) que con imágenes espectrales monocromáticas virtuales-MARS. Se consideraron no interpretables todas las regiones periprotésicas en las imágenes policromáticas y 11 (9%) en las imágenes espectrales monocromáticas virtuales-MARS. No hubo diferencias significativas en la dosis de radiación comparada con la del grupo control (p = 0,21). Conclusiones: La tomografía computarizada de doble energía puede reducir los artefactos periprotésicos, logrando un significativo incremento en la capacidad de identificar tejidos y la interpretabilidad diagnóstica de posibles patologías relacionadas con implantes. Nivel de Evidencia: II

Introduction: To explore the usefulness of dual energy imaging using gemstone spectral imaging technology and a dedicated software for metal artifact reduction (MARS) for the evaluation of periprosthetic tissues, and to assess image interpretability of implant-related complications. Methods: Signal density measurements were performed in periprosthetic and remote (control) areas in bone, soft tissue, and fat among 80 patients using a high definition scanner. Polychromatic images and virtual monochromatic spectral images with MARS were obtained, and image quality and diagnostic interpretability were evaluated using a Likert scale. Results: Using polychromatic images, the periprosthetic area showed significant differences compared to the remote areas among the three tissue explored (p<0.0001 for all); with no significant differences using virtual monochromatic spectral images-MARS (bone p=0.053, soft tissue p=0.32, fat p=0.13), suggesting similar signal density compared to normal (remote) tissue. Furthermore, periprosthetic polychromatic image noise levels were significantly higher than with virtual monochromatic spectral images-MARS (p<0.0001). All periprosthetic areas were deemed non-interpretable using polychromatic images, compared to 11 (9%) using virtual monochromatic spectral images-MARS. There were no differences in radiation dose compared to control group (p=0.21). Conclusions: Virtual monochromatic spectral images-MARS technology has the ability to reduce periprosthetic artifacts, achieving a significant increase to identify tissues and diagnostic interpretability of complications related to the implants. Level of Evidence: II

Periprosthetic Artifact Reduction Using Virtual Monochromatic Imaging Derived From Gemstone Dual-Energy Computed Tomography and Dedicated Software.

OBJECTIVE: The aim of this study was to explore the usefulness of combined virtual monochromatic imaging and metal artifact reduction software (MARS) for the evaluation of musculoskeletal periprosthetic tissue. METHODS: Measurements were performed in periprosthetic and remote regions in 80 patients using a high-definition scanner. Polychromatic images with and without MARS and virtual monochromatic images were obtained. RESULTS: Periprosthetic polychromatic imaging (PI) showed significant differences compared with remote areas among the 3 tissues explored (P < 0.0001). No significant differences were observed between periprosthetic and remote tissues using monochromatic imaging with MARS (P = 0.053 bone, P = 0.32 soft tissue, and P = 0.13 fat). However, such differences were significant using PI with MARS among bone (P = 0.005) and fat (P = 0.02) tissues. All periprosthetic areas were noninterpretable using PI, compared with 11 (9%) using monochromatic imaging. CONCLUSIONS: The combined use of virtual monochromatic imaging and MARS reduced periprosthetic artifacts, achieving attenuation levels comparable to implant-free tissue.