Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events.

BACKGROUND AND PURPOSE: Our aim was to assess the relationship between volume and percentage of intraplaque hemorrhage measured using CT and the occurrence of cerebrovascular events at the time of CT. MATERIALS AND METHODS: One-hundred-twenty-three consecutive subjects (246 carotid arteries) with a mean age of 69 years who underwent CTA were included in this retrospective study. Plaque volume of components and subcomponents (including intraplaque hemorrhage volume) was quantified with dedicated software. RESULTS: Forty-six arteries were excluded because no plaque was identified. In the remaining 200 carotid arteries, a statistically significant difference was found between presentation with cerebrovascular events and lipid volume (P = .002), intraplaque hemorrhage volume (P = .002), percentage of lipid (P = .002), percentage of calcium (P = .001), percentage of intraplaque hemorrhage (P = .001), percentage of lipid-intraplaque hemorrhage (P = .001), and intraplaque hemorrhage/lipid ratio (P = .001). The highest receiver operating characteristic area under the curve was obtained with the intraplaque hemorrhage volume with a value of 0.793 (P = .001), percentage of intraplaque hemorrhage with an area under the curve of 0.812 (P = .001), and the intraplaque hemorrhage/lipid ratio with an area under the curve value of 0.811 (P = .001). CONCLUSIONS: Results of our study suggest that Hounsfield unit values <25 have a statistically significant association with the presence of cerebrovascular events and that the ratio intraplaque hemorrhage/lipid volume represents a strong parameter for the association of cerebrovascular events.

Carotid Plaque CTA Analysis in Symptomatic Subjects with Bilateral Intraparenchymal Hemorrhage: A Preliminary Analysis.

BACKGROUND AND PURPOSE: The presence of IPH is considered the most dangerous feature because it is significantly associated with clinical ipsilateral cerebrovascular events. Our aim was to explore the characterization of plaque with CT in symptomatic subjects with bilateral intraplaque hemorrhage. MATERIALS AND METHODS: Three-hundred-forty-three consecutive patients with recent anterior circulation ischemic events (<2 weeks) and CT of the carotid arteries (performed within 14 days of the cerebrovascular event) evaluated between June 2012 and September 2017 were analyzed for plaque volume composition to identify all subjects with bilateral intraplaque hemorrhage. Plaque volume was semiautomatically measured, and tissue components were classified according to the attenuation values such as the following: calcified (for values of ≥130 HU), mixed (for values of ≥60 and <130 HU), lipid (for values of ≥25 and <60 HU), and intraplaque hemorrhage (for values of <25 HU). Twenty-one subjects (15 men; mean age, 70 ± 11 years; range, 44-87 years) had bilateral intraplaque hemorrhage and were included in the analysis. RESULTS: Volume measurement revealed significantly larger plaques on the symptomatic side compared with the asymptomatic one (mean, 28 ± 9 versus 22 ± 8 mm, P = .007). Intraplaque hemorrhage volume and percentage were also significantly higher in the plaque ipsilateral to the cerebrovascular event (P < .001 and < .001, respectively). The volume of other plaque components did not show a statically significant association except for lipid and lipid + intraplaque hemorrhage percentages (23% versus 18% and 11% versus 15%), which were significantly different between the symptomatic and the asymptomatic sides (.016 and .011, respectively). The intraplaque hemorrhage/lipid ratio was higher on the symptomatic side (0.596 versus 0.171, P = .001). CONCLUSIONS: In patients with bilateral intraplaque hemorrhage and recent ischemic symptoms, the plaque ipsilateral to the symptomatic side has significantly larger volume and a higher percentage of intraplaque hemorrhage compared with the contralateral, asymptomatic side.

Cribrilinids (Bryozoa, Cheilostomata) associated with deep-water coral habitats at the Great Bahama Bank slope (NW Atlantic), with description of new taxa.

Four cribrilinid bryozoans associated with deep-water corals (578-682 m depth) from the Great Bahama Bank slope, are described, two of them are new. The generic allocation of some species prompted us to raise the subgenera Puellina, Cribrilaria, and Glabrilaria to genus rank. The new combination Cribrilaria saginata (Winston, 2005) n. comb. is proposed. Genus Glabrilaria is reported from the NW Atlantic for the first time based on the description of Glabrilaria hirsuta Rosso n. sp. and Glabrilaria polita Rosso n. sp. The new genus Teresaspis Rosso n. gen. is erected, and Teresaspis lineata (Canu Bassler, 1928) n. comb. is proposed as its type species. The new genus Harmelinius Rosso n. gen. is erected for Cribrilina uniserialis (Harmelin, 1978). Both genera have uniserial colonies formed by slightly caudate zooids with extensive gymnocyst and a frontal shield of flattened costae. Teresaspis lineata n. comb., however, has costae with pelmatidia that are connected by few intercostal bridges and separated by intercostal spaces, four orificial costa-like processes with the proximal pair arching above the orifice, hyperstomial acleithral ovicells with a pseudoporous ooecium formed by the distal zooid or a kenozooid, two types of kenozooids (large with costate frontal shield and small with smooth shield and central opesia), and an ancestrula with costate frontal shield. Avicularia are apparently absent in this species. In contrast, the type species of Harmelinius Rosso n. gen. has costae lacking pelmatidia and which are separated by slit-like intercostal spaces. The hyperstomial cleithral ovicells have smooth ooecia with a median suture and without pseudopores, and are formed by a distal kenozooid associated with a small avicularium. Additional paired oral avicularia are occasionally present, as are large kenozooids with a central opesia. Oral spines or spine-like processes are absent. Taxonomy of the above reported cribrilinid genera is discussed in detail together with the geographic distribution of all mentioned taxa.

CT Attenuation Analysis of Carotid Intraplaque Hemorrhage.

BACKGROUND AND PURPOSE: Intraplaque hemorrhage is considered a leading parameter of carotid plaque vulnerability. Our purpose was to assess the CT characteristics of intraplaque hemorrhage with histopathologic correlation to identify features that allow for confirming or ruling out the intraplaque hemorrhage. MATERIALS AND METHODS: This retrospective study included 91 patients (67 men; median age, 65 ± 7 years; age range, 41-83 years) who underwent CT angiography and carotid endarterectomy from March 2010 to May 2013. Histopathologic analysis was performed for the tissue characterization and identification of intraplaque hemorrhage. Two observers assessed the plaque's attenuation values by using an ROI (≥ 1 and ≤2 mm2). Receiver operating characteristic curve, Mann-Whitney, and Wilcoxon analyses were performed. RESULTS: A total of 169 slices were assessed (59 intraplaque hemorrhage, 63 lipid-rich necrotic core, and 47 fibrous); the average values of the intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue were 17.475 Hounsfield units (HU) and 18.407 HU, 39.476 HU and 48.048 HU, and 91.66 HU and 93.128 HU, respectively, before and after the administration of contrast medium. The Mann-Whitney test showed a statistically significant difference of HU values both in basal and after the administration of contrast material phase. Receiver operating characteristic analysis showed a statistical association between intraplaque hemorrhage and low HU values, and a threshold of 25 HU demonstrated the presence of intraplaque hemorrhage with a sensitivity and specificity of 93.22% and 92.73%, respectively. The Wilcoxon test showed that the attenuation of the plaque before and after administration of contrast material is different (intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue had P values of .006, .0001, and .018, respectively). CONCLUSIONS: The results of this preliminary study suggest that CT can be used to identify the presence of intraplaque hemorrhage according to the attenuation. A threshold of 25 HU in the volume acquired after the administration of contrast medium is associated with an optimal sensitivity and specificity. Special care should be given to the correct identification of the ROI.

Long-term Follow-up and Post-relapse Outcome of Patients with Localized Retroperitoneal Sarcoma Treated in the Italian Sarcoma Group-Soft Tissue Sarcoma (ISG-STS) Protocol 0303.

BACKGROUND: This study was designed to assess patterns of recurrence and long-term outcomes of patients undergoing surgery for localized retroperitoneal sarcoma (RPS) after neoadjuvant high dose long-infusion ifosfamide (HLI) and radiotherapy (RT). METHODS: Patients received three cycles of HLI (14 g/m2). RT was started in combination with II cycle up to a total dose of 50.4 Gy. Surgery was scheduled 4-6 weeks after the end of RT. The primary endpoint was relapse-free survival (RFS) after surgery. Secondary endpoints were overall survival (OS), crude cumulative incidence of local recurrence (CCI-LR), and distant metastases (CCI-DM). For patients who relapsed, progression-free survival (PFS) and post-relapse OS were estimated. The trial was registered with ITASARC_*II_2004_003. RESULTS: Between 2003 and 2010, 83 patients were recruited. At a median follow-up of 91.7 months, 42 (56%) of 75 operated patients developed LR (n = 27) or DM (n = 10) or both LR and DM (n = 5) relapse. Seven-year RFS was 46.6% [95% confidence interval (CI) 29.6-52.4]. Thirty-two patients died. Seven-year OS rate was 63.2% (95% CI 42.7-66.0). The corresponding CCI of LR and DM were 37.4% [standard error (SE) 5.5%] and 20.0% (SE 12.6%), respectively. The only factor significantly associated with LR was FNCLCC grading, whereas histological subtype resulted associated with DM. At recurrence, 24 patients (57%) underwent surgery. Two-year post-relapse PFS and OS rates for patients developing LR or DM were 14.8, 41.0, 27.3, and 63.6%, respectively. CONCLUSIONS: LR after neoadjuvant CT-RT for RPS were predominantly infield. While almost one half of relapsed patients underwent further surgery, prognosis was poor.

Long-term morbidity after multivisceral resection for retroperitoneal sarcoma.

BACKGROUND: More than 60 per cent of patients treated surgically for primary retroperitoneal sarcoma survive for at least 5 years. Extended surgical resection has been proposed for primary disease, but long-term morbidity data are lacking. A cross-sectional study was conducted to assess the long-term morbidity of patients undergoing surgery for retroperitoneal sarcoma. METHODS: Patients operated on between January 2002 and December 2011 were eligible for the study. Long-term morbidity was evaluated based on a semistructured clinical interview. Lower limb function was assessed by means of the Lower Extremity Functional Scale (LEFS), a self-report questionnaire with a total score ranging from 0 (low functioning) to 80 (high functioning). Pain was investigated by means of the Brief Pain Inventory--Short Form, with pain intensity scores reported on a scale from 0 (no pain) to 10 (worst pain). RESULTS: Some 243 patients underwent surgery, and 101 of 160 patients who were alive at the time of the investigation responded to the study invitation letter. Finally, 95 patients were enrolled in the study. Sensory impairment of the limbs was reported in 72 patients (76 per cent). The median LEFS score was 60 (i.q.r. 43-73). Mean scores for the pain intensity items varied from 1.23 to 2.68. In multivariable analysis, there was no difference in median levels of creatinine at survey between patients who did or did not undergo nephrectomy (difference between median values 13 (95 per cent c.i. -4 to 30) µmol/l; P = 0.170). CONCLUSION: Severe chronic pain and lower limb motor impairment after multivisceral resection for retroperitoneal sarcomas are rare. Long-term renal function is not significantly impaired when nephrectomy is performed.

BRCA1 haplotype and clinical benefit of trabectedin in soft-tissue sarcoma patients.

BACKGROUND: This study aimed to determine whether the BRCA1 haplotype was associated with trabectedin efficacy in soft-tissue sarcoma (STS) patients. METHODS: We analysed BRCA1 single-nucleotide polymorphisms (SNPs) in tumour specimens from 135 advanced STS patients enrolled in published phase 2 trials or in a compassionate-use programme of trabectedin. Forty-four advanced STS patients treated with doxorubicin and 85 patients with localised STS served as controls. The 6-month nonprogression rate and overall survival (OS) were analysed according to BRCA1 haplotype using log-rank tests. RESULTS: A favourable BRCA1 haplotype (presence of at least one AAAG allele) was significantly associated with an improved 6-month nonprogression rate. It was the only variable significantly associated with OS. No correlations were found between outcomes for patients with localised or advanced STS treated with doxorubicin. CONCLUSIONS: The BRCA1 haplotype represents a potential DNA repair biomarker that can be used for the prediction of response to trabectedin in STS patients.

Correlation between radiological assessment and histopathological diagnosis in retroperitoneal tumors: analysis of 291 consecutive patients at a tertiary reference sarcoma center.

OBJECTIVES: Aim of study was to assess the correlation between computed tomography scan (CT) findings and histopathology. MATERIAL AND METHODS: Data were collected on consecutive patients with suspected retroperitoneal sarcoma (RPS) referred to a tertiary sarcoma center. Patients underwent contrast enhanced multi-detector CT scans. Radiological features of lesions were classified according to the presence of a fatty (Group A) mass, or non-fatty (Group B) mass, both subdivided according to homogeneity and intralesional high-contrasted appearance. Radiological classification was compared with histopathological diagnosis. Sensitivity, specificity, positive/negative predictive value (PPV, NPV) were analyzed. RESULTS: Of 291 patients, 103/291 (35.4%) masses were classified in Group A and 188/291 (64.6%) in Group B. Diagnosis of mesenchymal tumor was obtained in 231/291 cases (79%) and non-mesenchymal tumor in 60/291 (21%). Sensitivity and specificity of Group A for liposarcoma were 76.7% and 92.0%; PPV and NPV were 86.4% and 85.6%. Sensitivity of Group B for a mesenchymal tumor was 55.4% and specificity was 0%; PPV and NPV were 68.1% and 0%. CONCLUSIONS: None of radiological criteria were sufficient to anticipate a specific diagnosis, with the only exception of well differentiated liposarcoma and angiomyolipoma. In a series of suspected RPS, 21% of the lesions were finally non-mesenchymal tumors.

Commensal symbiosis between agglutinated polychaetes and sulfate-reducing bacteria.

Pendant bioconstructions occur within submerged caves in the Plemmirio Marine Protected Area in SE Sicily, Italy. These rigid structures, here termed biostalactites, were synsedimentarily lithified by clotted-peloidal microbial carbonate that has a high bacterial lipid biomarker content with abundant compounds derived from sulfate-reducing bacteria. The main framework builders are polychaete serpulid worms, mainly Protula with subordinate Semivermilia and Josephella. These polychaetes have lamellar and/or fibrillar wall structure. In contrast, small agglutinated terebellid tubes, which are a minor component of the biostalactites, are discontinuous and irregular with a peloidal micritic microfabric. The peloids, formed by bacterial sulfate reduction, appear to have been utilized by terebellids to construct tubes in an environment where other particulate sediment is scarce. We suggest that the bacteria obtained food from the worms in the form of fecal material and/or from the decaying tissue of surrounding organisms and that the worms obtained peloidal micrite with which to construct their tubes, either as grains and/or as tube encompassing biofilm. Peloidal worm tubes have rarely been reported in the recent but closely resemble examples in the geological record that extend back at least to the early Carboniferous. This suggests a long-lived commensal relationship between some polychaete worms and heterotrophic, especially sulfate-reducing, bacteria.

Mode of action of trabectedin in myxoid liposarcomas.

To elucidate the mechanisms behind the high sensitivity of myxoid/round cell liposarcoma (MRCL) to trabectedin and the suggested selectivity for specific subtypes, we have developed and characterized three MRCL xenografts, namely ML017, ML015 and ML004 differing for the break point of the fusion gene FUS-CHOP, respectively of type I, II and III. FUS-CHOP binding to the promoters of some target genes such as Pentraxin 3 or Fibronectin 1, assessed by chromatin immunoprecipitation, was strongly reduced in the tumor 24 h after the first or the third weekly dose of trabectedin, indicating that the drug at therapeutic doses causes a detachment of the FUS-CHOP chimera from its target promoters as previously shown in vitro. Moreover, the higher sensitivity of MRCL types I and II appears to be related to a more prolonged block of the transactivating activity of the fusion protein. Doxorubicin did not affect the binding of FUS-CHOP to target promoters. Histologically, the response to trabectedin in ML017 and ML015 was associated with a marked depletion of non-lipogenic tumoral cells and vascular component, as well as lipidic maturation as confirmed by PPARγ2 expression in western Blot. By contrast, in ML004 no major changes either in the cellularity or in the amount of mature were found, and consistently PPARγ2 was null. In conclusion, the data support the view that the selective mechanism of action of trabectedin in MRCL is specific and related to its ability to cause a functional inactivation of the oncogenic chimera with consequent derepression of the adypocytic differentiation.

Carotid artery wall thickness measured using CT: inter- and intraobserver agreement analysis.

SUMMARY: The purpose of this work was to compare inter- and intraobserver agreement in the analysis of CAWT by using MDCTA. The CAWT in 35 patients was quantified by 4 observers. Bland-Altman statistics were used to measure the agreement between observers. The results of our study demonstrated that the CAWT measured by using MDCTA shows a good reproducibility between observers by considering inter- and intraobserver agreement.

Status of the circle of Willis and intolerance to carotid cross-clamping during carotid endarterectomy.

PURPOSE: During carotid endarterectomy (CEA), an intolerance to the cross-clamping (CC) can occur. The purpose of this study was to evaluate whether preoperative magnetic resonance angiography (MRA) can predict CC intolerance. MATERIAL AND METHODS: Seventy-one patients (57 males, 14 females, mean age 71.8 years, age range 46-86 years) underwent 71 CEA procedures under local anaesthesia. Before CEA, patients underwent an MRA of the Circle of Willis (CoW) and were then classified into three groups: group A consisted of patients with a complete CoW, group B included patients with one agenesia/obstruction in the CoW and group C comprised patients with two or more agenesiae/obstructions in the CoW. The association between the number of anatomical variants in the CoW, corrected for the status of the contralateral carotid artery, and the onset of CC intolerance was evaluated. RESULTS: The prevalence of intolerance to CC was 15.5% (11/71). The Fisher test and logistic regression analysis showed a statistically significant association between the intolerance to CC and two or more agenesiae/obstructions in the CoW (p value < 0.00001 and p < 0.001, respectively). No neurological complications were observed. CONCLUSION: The results of our study showed that two or more agenesiae/obstructions of the CoW identified by MRA were associated with a high risk of intolerance to CC during CEA.

Venous thromboembolism is a relevant and underestimated adverse event in cancer patients treated in phase I studies.

BACKGROUND: To investigate, retrospectively, the role of tumour histotype and antiangiogenic drugs for venous thromboembolism (VTE) development in advanced cancer patients treated in phase I studies. METHODS: Patients enrolled and treated in phase I studies conducted by SENDO (Southern Europe New Drugs Organisation) were considered. RESULTS: Data of 1415 patients were included in the analysis: 526 (37.2%) patients were males, median age was 57.3 years (range: 13-85). Fifty-six (3.96%) patients developed a VTE. At multivariate analysis gynaecologic (hazard ratio (HR): 2.8, 95% confidence interval (CI): 1.29-6.23, P=0.009) and gastrointestinal tumours (HR: 3.23, 95% CI: 1.18-8.87, P=0.023) as well as combination regimens of cytotoxic and antiangiogenic agents (HR: 2.6, 95% CI: 1.11-6.30, P=0.028), white blood cell >11,000 µl(-1) (HR: 2.59, 95% CI: 1.10-6.09, P=0.028) and haemoglobin<10 g dl(-1) (HR: 3.1, 95% CI: 1.07-8.94, P=0.037) were statistically correlated with VTE development. Venous thromboembolism was the fourth most common cause of drug discontinuation. The median time from first drug administration to discontinuation was 1.4 for VTE and 2.3 months for the other adverse events (P=0.02). CONCLUSION: Venous thromboembolism is a relatively common complication among patients treated in the context of phase I studies, and may lead to early drug discontinuation. A greater risk of developing VTE is associated with the diagnosis of gynaecologic and gastrointestinal tumours and the combined use of chemotherapy and antiangiogenic drugs.

Association between carotid artery plaque type and cerebral microbleeds.

BACKGROUND AND PURPOSE: CMBs have become increasingly recognized with the widespread use of MR imaging techniques that are sensitive to iron deposits. The purpose of this study was to correlate the presence of CMBs and carotid plaque characteristics. MATERIAL AND METHODS: Seventy consecutive patients (47 men; 23 women; mean age, 65 years) were prospectively analyzed. Carotid arteries were studied using a 16-detector row CT scanner, whereas the brain was explored with an MR imaging 1.5T system. CMBs were studied using a T2*-weighted GRE sequence. CMBs were classified by an ordinal scale and carotid plaques were characterized based on their composition as fatty, mixed, or calcified. Patients were classified as symptomatic and asymptomatic. Chi-square and multiple logistic regression analyses, as well as ROCs, were calculated. RESULTS: The prevalence of CMBs was 30%. A statistically significant difference in CMB prevalence was observed between symptomatic (46%) and asymptomatic (19%) patients (P value = .0021; OR = 3.7). Correlation analysis demonstrated an association between the number of CMBs and the symptoms (P = .0001). A statistically significant association was observed between the presence of fatty plaque and CMBs (P = .0019). CONCLUSIONS: The results of this study suggest an association between the presence of carotid artery fatty plaque, symptoms, and CMBs. Moreover, we found that the presence (and entity) of CMBs may represent an indicator of cerebrovascular symptom severity.

Frontline extended surgery is associated with improved survival in retroperitoneal low- to intermediate-grade soft tissue sarcomas.

BACKGROUND: The purpose of the study was to retrospectively reassess in our institutional series at a longer follow-up the value of a systematic attempt to carry out wide resections in retroperitoneal soft tissue sarcoma. PATIENTS AND METHODS: Three hundred and thirty-one consecutive patients surgically treated were analyzed. Since a shift toward a systematic more extended surgical approach took place starting from 2002, patients were divided in two groups according to the time of surgery. Overall survival (OS), crude cumulative incidence of local recurrence (LR) and distant metastases (DMs) were estimated. Cox model multivariate analysis was carried out. RESULTS: Five-year OS of patients operated in the recent period was 66%, compared with 48% for those operated in the previous period. This was associated with less LR (28% versus 49%), while the number of DMs was higher in the recent group (25% versus 12%). Beside the treatment period, the only independent determinant for survival was histological grade. CONCLUSIONS: The adoption of a policy of more liberal visceral en bloc resections was associated with a higher local control and OS. This benefit was evident in patients with grade I-II tumors, while DMs were a limiting factor in high-grade ones. New therapies are needed to control systemic disease as local surgery may improve local control.

Gemcitabine in advanced angiosarcoma: a retrospective case series analysis from the Italian Rare Cancer Network.

BACKGROUND: Angiosarcoma is a highly aggressive soft tissue sarcoma. Responses to anthracyclines plus/minus ifosfamide, and taxanes alone or in combination with gemcitabine are well documented. Very few data are available on gemcitabine as a single agent. PATIENTS AND METHODS: We retrospectively reviewed all cases of advanced progressive angiosarcoma treated with gemcitabine as a single agent (1000 mg/m(2) i.v. every week for 3 weeks every 4 weeks), at Istituto Nazionale Tumori and within the Italian Rare Cancers Network from January 2008 to November 2010. RESULTS: Twenty-five patients [mean age: 52 years; radiation therapy (RT)-related: 8] received gemcitabine. Best tumor response by RECIST was as follows: complete response = 2, partial response = 14, stable disease = 2, progressive disease = 7 cases, for an overall response rate (PR + CR) of 68%. Six of eight post-RT angiosarcomas responded to treatment. Median overall survival (OS) was 17 months. Median progression-free survival (PFS) was 7 months (range 1-40 months). One patient with a locally advanced thyroid angiosarcoma became resectable after 5 months of gemcitabine, with <10% residual viable tumor cells seen on surgical specimen. Overall, gemcitabine was well tolerated. CONCLUSIONS: Gemcitabine is active in both RT- and non-RT-related angiosarcoma, with dimensional and possibly long-lasting responses. A formal phase II study on gemcitabine as a single agent is warranted.

Carotid artery wall thickness and leukoaraiosis: preliminary results using multidetector row CT angiography.

BACKGROUND AND PURPOSE: LA is a condition caused by chronic cerebral ischemia and it represents an independent risk for stroke. The purpose of this work was to determine whether CAWT studied by using MDCTA is correlated with LA and its severity. MATERIALS AND METHODS: Ninety-eight patients ≥60 years of age were retrospectively studied by using multidetector row CT. Supra-aortic vessel analysis and brain CT were performed in the same procedure. In each patient, CAWT was measured with an internal digital caliper, and the presence and severity of LA were assessed. Correlation coefficients by using Spearman statistics and ROC curves were calculated. A P value < .05 was considered statistically significant. RESULTS: Measurements of the distal common CAWT ranged from 0.5 to 1.53 mm. A correlation between LA and increased CAWT was observed (Pearson correlation, 0.33; P < .001). On the basis of a threshold of 0.9 mm, an important statistical association between increased CAWT and LA (P < .0001) was found. With the same threshold, ROC curve analysis indicated a sensitivity of 55% and a specificity of 75% for LA. CONCLUSIONS: The results of this study show a statistically significant correlation between increased CAWT and LA (and its severity).

Study of endoleaks after endovascular repair by using MDCTA.

PURPOSE: Our purpose was to investigate the multi-detector-row CT angiography (MDCTA) application in endoleak detection. METHODS: Fifty-nine patients that underwent endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm with endoluminal stent graft were retrospectively studied. MDCTA scans were obtained after administration of 110-130 mL of contrast material using a 4-6 mL/sec flow rate. We made unenhanced, arterial (15-20 sec) and delayed (100 sec) acquisitions. For each patient four MDCTA datasets (pre-EVAR, 1, 6, and 12 months follow-up) were obtained. Each examination was studied by two observers. Kappa value was calculated in order to evaluate inter-observer agreement. RESULTS: Twenty-one endoleaks were detected in eighteen patients. Fifteen and eighteen endoleaks were detected by using biphasic arterial CT and biphasic delayed CT respectively (sensitivity of 71.4% and 85.7% respectively). We observed a positive correlation between the presence of endoleak and the increasement in aneurysm size. Interobserver agreement was 88.1% and kappa value was 0.685. CONCLUSIONS: Biphasic CT for endoleak detection is significantly superior to arterial and delayed phases respectively. We observed a good interobserver agreement.

Associations between carotid artery wall thickness and cardiovascular risk factors using multidetector CT.

BACKGROUND AND PURPOSE: It has been demonstrated that the increase in CAWT is associated with an increased risk of stroke and its severity. The aim of this study was to determine whether CAWT evaluated by MDCTA is associated with the following cardiovascular risk factors: hypertension, diabetes mellitus, dyslipidemia, and smoking. MATERIALS AND METHODS: This was a retrospective study. One hundred sixty-eight patients (120 men; mean age, 68.96 years ± 11.2 years SD) were analyzed by using a multidetector row CT scanner. In each patient, CAWT was measured by using an internal digital caliper. Continuous data were described as the mean value ± SD and were compared by using the Student t test. We performed simple logistic regressions to evaluate the association between CAWT and the following: hypertension, diabetes mellitus, dyslipidemia, and smoking. A P value < .05 indicated statistical significance. RESULTS: The distal common CAWT varied from 0.5 to 1.5 mm. We observed that hypertension and diabetes mellitus were associated with increased (>1 mm) CAWT (P = .0041 and P = .0172, respectively). There was no significant association between increased CAWT and dyslipidemia or smoking. CONCLUSIONS: In our selected group, the results of this work show that an increased CAWT is associated with the cardiovascular risk determinants hypertension and diabetes. Further studies are necessary to evaluate whether it is possible to apply our observations to the general population.

Superior mesenteric artery spontaneous and isolated dissection diagnosed by using MDCTA.

We report the case of a 49-year-old man admitted to our Institute because he suffered acute abdominal pain induced by eating. Sonography don't revealed pathological findings. Then underwent a multi-detector row computed tomography angiography (MDCTA) that revealed an intimal flap separating true and false lumens that was located 2 cm from the origin of the superior mesenteric artery (SMA) and with an extension of 8 cm. Since the dissection was limited without occlusion of the SMA and the mesenteric marginal artery served as a collateral vessel on the distal side of the SMA, the treatment has been conservative. Improved CT technology facilitates the diagnosis of superior mesenteric artery dissection. Prompt diagnosis and treatment result in the lowest mortality rate and minimize the prevalence of intestinal infarction. Only 107 cases (including the present case) of isolated spontaneous SMA dissection without associated aortic dissection were identified from the literature.