Evaluation of subclinical cardiovascular risk in drug-naive pediatric patients with anxiety disorders.

OBJECTIVE: This study examined subclinical atherosclerosis in drug-naïve children with anxiety disorders using non-invasive measures to investigate the clinical features associated with subclinical atherosclerosis. METHOD: A total of 37 drug-naive children and adolescents with anxiety disorders and 37 healthy controls were included in the study. The Children's Depression Inventory (CDI) and the State-Trait Anxiety Inventory (STAI-T and STAI-S) were used to assess children's depression and anxiety levels. Carotid artery intima-media (cIMT), epicardial adipose tissue (EAT), and periaortic adipose tissue (PAT) thicknesses, which are indicators of subclinical atherosclerosis, were obtained by echocardiographic measurements. RESULTS: Multivariate analysis of covariance (MANCOVA) revealed a significant main effect on cIMT, EAT thickness, and PAT thickness, independent of confounding factors such as age, sex, body mass index, mean blood pressure, and family income (Pillai's Trace V = .76, F (1, 72) = 35.60, P < .001, ηp2 = .76). Analysis of covariance (ANCOVA) showed that cIMT, EAT thickness, and PAT thickness values were significantly higher in the anxiety disorder group compared to the the control group (P < .001). In partial correlation analysis, a positive correlation was observed between STAI-T and cIMT and EAT thickness. In linear regression analyses, age and STAI-T were significantly correlated with cIMT and EAT thickness levels. CONCLUSIONS: These results suggest that subclinical cardiovascular risk is significantly increased in children and adolescents with anxiety disorders.

Early periaortic hematoma development after EVAR in the presence of severely calcified and modestly conical-shaped aortic neck: A potential trigger for sudden aneurysm progression toward rupture.

OBJECTIVE: The aim of this report is to present a singular case of early post-endovascular aneurysm repair abdominal aortic aneurysm rupture and discuss the possible etiopathogenic mechanism promoting the sudden aneurysm progression toward rupture.Methods/Results: An 84-year-old man was submitted to endovascular aneurysm repair via second-generation endograft (Cordis-Incraft Stent-graft) during which, the left occluded common iliac artery was recanalized via balloon-expandable covered-stent-graft (Atrium-Advanta-V12). The aneurysm presented a severely calcified and modestly conical-shaped aortic-neck. The post-operative course was complicated by a broncho pneumonic infiltrate and a CT scan performed two weeks postoperatively accidentally revealed a relatively small hematoma surrounding the aortic wall. No active bleeding, endoleak, or aneurysm increase in diameter was documented. Nevertheless, the patient remained closely monitored. Three days later, he suffered from abdominal aortic aneurysm rupture. A CT scan revealed an arterial wall tear at the neck level. Intra-operatively the reanalyzed common iliac artery was intact and a good endograft-sealing was confirmed. Following this event, small lumbar arteries suture saccotomy was performed. The patient eventually died of multiorgan failure one month later. CONCLUSIONS: The apparently "self-limiting" post-endovascular aneurysm repair CT-scan finding of periaortic hematoma may have represented a potential trigger for abdominal aortic aneurysm rupture. The possibility of developing undetected aortic lesions during endovascular aneurysm repair, specifically in the presence of potentially "at risk" anatomical conditions, should always be considered.

Clostridium septicum aortitis: A kiss of the devil.

BACKGROUND: Clostridium septicum aortitis is a lethal infection. C. septicum has a strong association with an underlying malignancy, most commonly in the colon. AIM: Early identification methods and management strategies of C. Septicum infection. MATERIALS AND METHODS: We present a 64-year-old man with aortic aneurysm and C. septicum bacteremia with unknown malignancy who passed away on the fourth day of hospitalization despite emergent endovascular intervention. Computed tomography showed periaortic gas which is the hallmark of infection. DISCUSSION: This case report highlights the need of prompt surgical treatment and its different modalities along with the early use of appropriate antibiotics due to the rapid spread of infection associated with high fatality. The authors also discuss the association of C. septicum aortitis with underlying occult malignancies. CONCLUSION: Delay in identification and treatment of C. Septicum is associated with very high mortality rates.

Prostaglandin-E2 deficiency during late pregnancy and the associated increase in interleukin-1ß derived from periaortic lymph nodes lead to abortion.

Prostaglandin E2 (PGE2) is a hormone with many physiological functions. During pregnancy, it is generally believed that there is a high level of PGE2 at the final stage of pregnancy, which induces the contraction of uterine smooth muscle and promotes the occurrence of childbirth. However, we find that high PGE2 levels are present throughout late pregnancy in mice, not just during childbirth, and that PGE2 deficiency induced by indomethacin during late pregnancy causes damage to the placental labyrinth and eventually leads to abortion. Interestingly, the damage is closely related to inflammation, which involves the role of inflammatory factors produced by the periaortic lymph nodes (PLNs) near the uterus. Further, through RNA sequencing, we reveal that PLNs produce a large amount of interleukin-1ß (IL-1ß) when exposed to PGE2 deficiency, which causes damage to the placental labyrinth, probably via destroying the extracellular matrix. Finally, events leading to abortion following indomethacin administration are effectively prevented by supplementing PGE2 or by PLN removal. These results suggest that high levels of PGE2 during late pregnancy protect fetuses from inflammatory damage related to IL-1ß. This work suggests a new role of PGE2 during late pregnancy and may provide potential therapeutic strategies for pathological pregnancy.

Transplantation of periaortic adipose tissue inhibits atherosclerosis in apoE-/- mice by evoking TGF-ß1-mediated anti-inflammatory response in transplanted graft.

Perivascular adipose tissue (PAT) is associated with vascular homeostasis; however, its causal effect on atherosclerosis currently remains undefined. Here, we investigated the effect of experimental PAT transplantation on atherosclerosis. The thoracic periaortic adipose tissue (tPAT) was dissected from 16-week-old wild-type mice and transplanted over the infrarenal aorta of 20-week-old apoE deficient (apoE-/-) mice fed high-cholesterol diet for 3 months. Oil-red O staining after 4 weeks showed a significant 20% decrease in the atherosclerotic lesion of suprarenal aorta compared with that of sham control mice, while that of infrarenal aorta showed no difference between the two groups. TGF-ß1 mRNA expression was significantly higher in grafted tPAT than donor tPAT, accompanied by a significant increase in serum TGF-ß1 concentration, which was inversely correlated with the suprarenal lesion area (r = -0.63, P = 0.012). Treatment with neutralizing TGF-ß antibody abrogated the anti-atherogenic effect of tPAT transplantation. Immunofluorescent analysis of grafted tPAT showed that TGF-ß-positive cells were co-localized with Mac-2-positive cells and this number was significantly increased compared with donor tPAT. There was also marked increase in mRNA expression of alternatively activated macrophages-related genes. Furthermore, the percentage of eosinophils in stromal vascular fraction of donor tPAT was much higher than that in epididymal white adipose tissue, concomitant with the significantly higher protein level of IL-4. IL-4 mRNA expression levels in grafted tPAT were increased in a time-dependent manner after tPAT transplantation. Our findings show that tPAT transplantation inhibits atherosclerosis development by exerting TGF-ß1-mediated anti-inflammatory response, which may involve alternatively activated macrophages.

A Benign but Unusual Radiological Sign During EVAS Follow-up.

PURPOSE: To report a heretofore undescribed complication seen on imaging after endovascular aortic sealing (EVAS). CASE REPORT: A 77-year-old woman was treated with the Nellix EVAS device for an infrarenal aortic aneurysm. After a normal computed tomography (CT) scan at 15 days, the 6-month CT showed the onset of perianeurysmal inflammatory tissue. The patient was asymptomatic, and blood tests were normal. Imaging suggested a nonaggressive inflammatory process, so a conservative approach was adopted with close follow-up. The periaortic tissue remitted without any treatment after a further 9 months (16 months after EVAS). CONCLUSION: The cause of this nonacute complication is unclear. Some clues suggest that interaction between the endobags and aneurysm wall could be involved. Imaging and clinical data led to a successful conservative strategy.

Clinical Outcomes After Endovascular Repair and Open Surgery to Treat Immunoglobulin G4-Related and Nonrelated Inflammatory Abdominal Aortic Aneurysms.

PURPOSE: To compare the follow-up results of endovascular aneurysm repair (EVAR) vs open surgery (OS) for inflammatory abdominal aortic aneurysms (IAAAs) with regard to immunoglobulin G4-related diseases (IgG4-RD), which are fibrous inflammatory conditions characterized by elevated serum IgG4 concentrations and numerous infiltrations of IgG4+ plasmacytes. METHODS: Between January 2005 and December 2015, 91 patients were treated with EVAR (begun in 2008) and 166 patients underwent OS for AAA. Forty of these 257 patients had IAAAs identified by a >2-mm thickness of periaortic fibrosis (PAF). Of these 40, 21 had pathologically confirmed IgG4-RD and/or serum IgG4 concentrations ≥135 mg/dL (classified IgG4+); 8 (mean age 76 years; 8 men) were treated with EVAR and 13 (mean age 71 years; 11 men) underwent OS. Of the 19 IgG4- patients with IAAA, 9 (mean age 71 years; 8 men) had EVAR and 10 (mean age 75 years; 9 men) had OS. The 4 subgroups were compared in terms of symptoms, complications, inflammation markers, PAF, and aneurysm diameter using the latest midterm follow-up data (12-24 months). RESULTS: Preoperative aneurysm diameter, PAF, gender, median age, symptoms, and median follow-up period were similar in all groups. Preoperative serum IgG4 was equal in EVAR and OS IgG4+ groups. Compared with the OS IgG4+ group, EVAR IgG4+ patients more frequently had postoperative IgG4 increase (5/8; p=0.006) and PAF progression (5/8; p=0.027), higher postoperative serum IgG4 levels (median 141 mg/dL; p=0.034), a thicker postoperative PAF (median 5.1 mm; p=0.016), and persistent clinical symptoms (p=0.006). Compared with EVAR IgG4- patients, the EVAR IgG4+ patients showed significantly thicker postoperative PAF (p=0.024) and larger increases in postoperative sac diameter (median +13.1 mm; p=0.030). Postoperative PAF and sac diameter frequently and synchronously became worse in the EVAR IgG4+ subgroup with increased IgG4 during follow-up. The rate of change in IgG4 significantly positively correlated with the rates of change in PAF (R=0.555, p=0.03) and sac diameter (R=0.902, p=0.003). CONCLUSION: Though sample sizes were rather small, this pilot study suggested that EVAR-treated IgG4+ IAAA patients have a higher risk of persistent symptoms and increases in PAF, sac diameter, and IgG4 levels. Therefore, OS should be preferred for complete recovery. Frequent monitoring of the postoperative serum IgG4 is necessary following EVAR in IgG4+ patients to detect these complications.

Mycoplasma hominis periaortic abscess following heart-lung transplantation.

We report the first case of Mycoplasma hominis periaortic abscess after heart-lung transplantation. The absence of sternal wound infection delayed the diagnosis, but the patient successfully recovered with debridement surgeries and long-term antibiotic therapy. Owing to the difficulty in detection and the intrinsic resistance to beta-lactams, M. hominis infections are prone to being misdiagnosed and undertreated. M. hominis should be suspected in cases where conventional microbiological identification and treatment approaches fail.

Aortic perivascular adipose-derived interleukin-6 contributes to arterial stiffness in low-density lipoprotein receptor deficient mice.

We tested the hypothesis that aortic perivascular adipose tissue (PVAT) from young low-density lipoprotein receptor-deficient (LDLr(-/-)) mice promotes aortic stiffness and remodeling, which would be mediated by greater PVAT-derived IL-6 secretion. Arterial stiffness was assessed by aortic pulse wave velocity and with ex vivo intrinsic mechanical properties testing in young (4-6 mo old) wild-type (WT) and LDLr(-/-) chow-fed mice. Compared with WT mice, LDLr(-/-) mice had increased aortic pulse wave velocity (407 ± 18 vs. 353 ± 13 cm/s) and intrinsic mechanical stiffness (5,308 ± 623 vs. 3,355 ± 330 kPa) that was associated with greater aortic protein expression of collagen type I and advanced glycation end products (all P < 0.05 vs. WT mice). Aortic segments from LDLr(-/-) compared with WT mice cultured in the presence of PVAT had greater intrinsic mechanical stiffness (6,092 ± 480 vs. 3,710 ± 316 kPa), and this was reversed in LDLr(-/-) mouse arteries cultured without PVAT (3,473 ± 577 kPa, both P < 0.05). Collagen type I and advanced glycation end products were increased in LDLr(-/-) mouse arteries cultured with PVAT (P < 0.05 vs. WT mouse arteries), which was attenuated when arteries were cultured in the absence of PVAT (P < 0.05). PVAT from LDLr(-/-) mice secreted larger amounts of IL-6 (3.4 ± 0.1 vs. 2.3 ± 0.7 ng/ml, P < 0.05), and IL-6 neutralizing antibody decreased intrinsic mechanical stiffness in LDLr(-/-) aortic segments cultured with PVAT (P < 0.05). Collectively, these data provide evidence for a role of PVAT-derived IL-6 in the pathogenesis of aortic stiffness and remodeling in chow-fed LDLr(-/-) mice.

Periaortic Fat Tissue: A Predictor of Cardiac Valvular Calcification, Malnutrition, Inflammation, and Atherosclerosis Components in Hemodialysis Patients.

Cardiac valvular calcification (CVC) in end-stage renal disease is shown to be a component of malnutrition, inflammation, atherosclerosis, calcification (MIAC) syndrome. Thoracic periaortic fat tissue (T-PAFT) is shown to be increased in patients with end-stage renal disease (ESRD), and has positive correlation with MIAC. Negative correlation between CVC and vitamin D is shown in hemodialysis (HD) patients. In this study, we investigated a relationship between body composition, T-PAFT, metabolic and inflammatory parameters, and CVC in HD patients. Seventy-six HD patients (49M) were included. CVC is defined as bright echoes of >1 mm on one or more cusps on echocardiography. Results were expressed as the number of calcified valves (0,1,2). Calcium, phosphorus, parathyroid hormone (PTH), C-reactive protein (CRP), albumin and 25-hydroxy vitamin D levels were studied from predialysis blood samples. T-PAFT was calculated using a method with manual definition of borders on images from multislice computed tomography. Basal metabolic rate, muscle mass, total and truncal fat mass were measured by bioimpedance analysis. There were 65.8% of patients who had CVC. Patients with CVC were older (63.5 ± 14.6 ± 17, P = 0.02). T-PAFT (1599 ± 596, 739.7 ± 179 mm(2) , P = 0.001) and CRP (15.8 ± 11; 11.1 ± 13.2 mg/dL; P = 0.04) were higher in the group with CVC. T-PAFT had positive correlations with CRP, MIAC, body mass index (BMI) and number of calcified valves, negative correlation with left ventricular ejection fraction, and no correlation with albumin, calcium, phosphorus, and PTH. The logistic regression analysis revealed that T-PAFT was a significant predictor of CVC. In this study, T-PAFT showed a positive correlation with inflammation, CVC, and MIAC score in HD patients. T-PAFT was a significant predictor of CVC.

Management of a periaortic spinal pedicle screw in a patient with adult presentation thoracic scoliosis.

Introduction: Vascular injury due to direct contact with malpositioned pedicle screws is perhaps the most devastating complication associated with screw instrumentation. While frank perforation of major vessels warrants urgent open or endovascular repair, the management of pedicle screws in close vicinity of large vessels is unclear. We present a systematic multi-disciplinary approach to manage a patient with a periaortic pedicle screw. Case Report: A 20-year-old female underwent posterior scoliosis correction and spinal fusion for an adult thoracic scoliosis with spinal instrumentation extending from T3-T12. In the immediate post-operative period, an episode of acute desaturation prompted a computed tomography pulmonary angiography (CTPA) to rule out pulmonary embolism. While CTPA demonstrated an enlarged right side of the heart (corresponding to a large atrial septal defect as evident on 2D-ECHO), an incidental lateral breech at the left T10 pedicle screw level was also identified with the screw tip in close proximity to the aorta. At this time, cardiac management was prioritized and a successful atrial septal defect repair procedure was performed. After recovery from the cardiac procedure, a plan was formulated with a multidisciplinary team to remove the pedicle screw. To determine the exact position of the screw tip in relation to the aorta, an angiogram and an intravascular ultrasound were done which showed no evidence of intra-luminal extension of the screw tip. In addition, a transesophageal ultrasound was performed and this ruled out any extra-luminal contact with the aorta. Subsequently, the spinal instrumentation was removed safely with the vascular surgeon and interventional radiologist being on standby. Conclusion: The authors suggest the removal of spinal pedicle screws in proximity to major vessels and describe an algorithm for this. Thorough pre-operative planning and detailed vascular imaging, as well as a multidisciplinary approach resulting in a clear surgical plan are critical to allow safe removal of such implants.

CT Attenuation of Periaortic Adipose Tissue in Abdominal Aortic Aneurysms.

Purpose To assess periaortic adipose tissue attenuation at CT angiography in different abdominal aortic aneurysm disease states. Materials and Methods In a retrospective observational study from January 2018 to December 2022, periaortic adipose tissue attenuation was assessed at CT angiography in patients with asymptomatic or symptomatic (including rupture) abdominal aortic aneurysms and controls without aneurysms. Adipose tissue attenuation was measured using semiautomated software in periaortic aneurysmal and nonaneurysmal segments of the abdominal aorta and in subcutaneous and visceral adipose tissue. Periaortic adipose tissue attenuation values between the three groups were assessed using Student t tests and Wilcoxon rank sum tests followed by a multiregression model. Results Eighty-eight individuals (median age, 70 years [IQR, 65-78]; 78 male and 10 female patients) were included: 70 patients with abdominal aortic aneurysms (40 asymptomatic and 30 symptomatic, including 24 with rupture) and 18 controls. There was no evidence of differences in the periaortic adipose tissue attenuation in the aneurysmal segment in asymptomatic patients versus controls (-81.44 HU ± 7 [SD] vs -83.27 HU ± 9; P = .43) and attenuation in nonaneurysmal segments between asymptomatic patients versus controls (-75.43 HU ± 8 vs -78.81 HU ± 6; P = .08). However, symptomatic patients demonstrated higher periaortic adipose tissue attenuation in both aneurysmal (-57.85 HU ± 7; P < .0001) and nonaneurysmal segments (-58.16 HU ± 8; P < .0001) when compared with the other two groups. Conclusion Periaortic adipose tissue CT attenuation was not increased in stable abdominal aortic aneurysm disease. There was a generalized increase in attenuation in patients with symptomatic disease, likely reflecting the systemic consequences of acute rupture. Keywords: Abdominal Aortic Aneurysm, Periaortic Adipose Tissue Attenuation, CT Angiography ClinicalTrials.gov registration no. NCT02229006 © RSNA, 2024.

Metastatic Axillary Cutaneous Squamous Cell Carcinoma in an African-American Female: A Rare Case.

Cutaneous squamous cell carcinoma (cSCC) is a common skin cancer, typically affecting older White males in sun-exposed areas, and metastasis is rare. We present a unique case of a 46-year-old obese African-American woman with a recurrent, deep abscess in her left axilla. It was initially treated with several incision and drainage procedures and antibiotics. Despite multiple interventions, the abscess recurred with severe pain and drainage. Subsequent biopsies revealed a high-grade malignant neoplasm, later confirmed as poorly differentiated cSCC with primary metastases to the lungs and secondary metastases to the adrenal glands and periaortic lymph nodes. Immunohistochemical staining supported the diagnosis. The patient's atypical presentation, including her race, a non-sun-exposed site, and younger age, highlights the need for vigilance in diagnosing cSCC in atypical cases. This case underscores the importance of early consideration of cSCC in differential diagnoses for persistent or recurrent abscesses, which can facilitate timely treatment, potentially preventing extensive metastasis and improving patient outcomes.

Periaortic adipose tissue-specific activation of the renin-angiotensin system contributes to atherosclerosis development in uninephrectomized apoE-/- mice.

Chronic kidney disease (CKD) is an independent risk factor for the development of cardiovascular disease. The perivascular adipose tissue is closely implicated in the development of atherosclerosis; however, the contribution to CKD-associated atherogenesis remains undefined. Eight-week-old apoE-deficient mice were uninephrectomized and fed a high-cholesterol diet starting at 12 wk of age. The atherosclerotic lesion area in the thoracic aorta was comparable in 16-wk-old uninephrectomized (UNX) mice and sham control mice; however, the lesion area was markedly exaggerated in 20-wk-old UNX mice compared with the control (54%, P < 0.05). While the accumulation of monocytes/macrophages and the mRNA expression levels of inflammatory cytokines/chemokines in the thoracic periaortic adipose tissue (PAT) did not differ between the two groups, angiotensinogen (AGT) mRNA expression and the angiotensin II (ANG II) concentration in the PAT were significantly higher in 16-wk-old UNX mice than in the control (1.9- and 1.5-fold increases vs. control, respectively; P < 0.05). ANG II concentrations in both the plasma and epididymal white adipose tissue (WAT) were comparable between the two groups, suggesting that PAT-specific activation of the renin-angiotensin system (RAS) is primarily involved in CKD-associated atherogenesis. The homeostasis model assessment-insulin resistance (HOMA-IR) index and plasma insulin level after glucose loading were significantly elevated in 16-wk-old UNX mice. In vitro stimulation of preadipocytes with insulin exaggerated the AGT mRNA expression along with increased mRNA expression of PPARγ. These findings suggest that PAT-specific RAS activation probably primarily contributes in accelerating atherosclerotic development in UNX mice and could thus represent a therapeutic target for preventing CKD-associated atherogenesis.

Spontaneous peri-aortic hematoma in a patient with new-onset chest pain.

Peri-aortic hematoma formation is a common sequela of esophageal rupture and aortic dissection, but non-traumatic spontaneous hematoma formation is an uncommon finding. We present the case of a spontaneous peri-aortic hematoma in a 66-year-old male with associated left atrial thrombus. This 66-year-old male presented to a local emergency department with non-radiating epigastric and mid-sternal chest pain and was found to have a non-traumatic peri-aortic hematoma of unknown etiology that developed over a period of 12 hours. Imaging revealed a newly formed left atrial thrombus causing mass effect on the pulmonary veins and a newly formed left-sided pleural effusion. The patient was subsequently transferred to an outside facility for higher level of care where additional pathological etiologies of hematoma were further excluded. Before discharge, the hematoma spontaneously dissipated and the patient was discharged on oral anticoagulants for treatment of the atrial thrombus and advised to follow-up on an outpatient basis with hematology and cardiology specialists.

Aortocaval Fistula: A Rare Complication of an Infrarenal Aortic Aneurysm.

Teaching Point: Aortocaval fistula is a rare complication of infrarenal aortic aneurysms.

Safety and accuracy of aortic and periaortic CT-guided percutaneous core needle biopsy.

PURPOSE: The purpose of this study was to determine the safety and accuracy of aortic and periaortic computed tomography (CT)-guided percutaneous core needle biopsy performed at a single center over 12 years. MATERIALS AND METHODS: A retrospective review was conducted of cases performed between February 2010 and August 2022 in which the biopsied region was in direct contact with the aorta or great vessels including the pericardium and common iliac arteries. Clinical notes were reviewed for any early or delayed complications following the procedure, which if present were graded using the National Institute of Health's Common Terminology Criteria for Adverse Events, version 5.0. Pathology results were compared to subsequent outside biopsy results or follow-up surgical pathology, if available, as well as subsequent clinical decision making and/or clinical course, to determine concordance. Sensitivity, specificity, predictive value, and accuracy (indicative of diagnostic yield) were calculated. RESULTS: 32 core needle biopsies were reviewed from 30 patients (average lesion longest diameter 3.1 cm, range 0.5-10.9 cm; average needle proximity to the vessel endothelium or deep side of the pericardium 1.0 cm, range 0.3-1.8 cm). Complications occurred in 46.9% of cases (15/32), 93.3% (14/15) of which were minor and included small amounts of bleeding or pain. One patient developed a small nonemergent pneumothorax. Of biopsies obtained, 96.9% provided adequate tissue for diagnosis (31/32). When evaluating concordance between pathological and final diagnosis, sensitivity was 94.7% and specificity was 83.3%; positive and negative predictive value were 90.0% and 90.9%, respectively. Accuracy (diagnostic yield) of biopsy was 90.3%. CONCLUSION: CT-guided percutaneous aortic and periaortic core needle biopsies are safe and efficacious procedures with high diagnostic yield.

Fibrosing Mediastinitis Causing High Degree AV Block in a Young Female Patient.

A 30-year-old woman presented with presyncopal episodes and was found to have high degree atrioventricular block. Computed tomography imaging demonstrated pericardial thickening extending from the main pulmonary artery to the aortic cusps. Here we present a rare case of fibrosing mediastinitis causing high-degree atrioventricular block. (Level of Difficulty: Intermediate.).

Cardiovascular Disease Risk in Children and Adolescents with Attention Deficit/Hyperactivity Disorder.

Objective: The aim of this case-controlled study is to evaluate chronic inflammation, subclinical atherosclerosis and cardiovascular disease risk in children and adolescents with ADHD. Methods: A total of 51 medication-free children and adolescents with ADHD and 51 healthy controls were included in this study. K-SADS-PL was used to determine the diagnosis of ADHD and other psychiatric disorders. Conners' Parent Rating Scale-Revised Short Form and the Conners' Teacher Rating Scale-Revised Short Form severity of ADHD was used to evaluate severity of ADHD. In order to evaluate subclinical atherosclerosis, common carotid intima media thickness (IMT), epicardial adipose tissue thickness (EAT), and periaortic adipose tissue thickness (PAT) were assessed as well as clinical parameters. Results: The IMT (0.037 ± 0.005 cm vs. 0.026 ± 0.003 cm), EAT (0.472 ± 0.076 cm vs. 0.355 ± 0.051 cm), and PAT (0.135 ± 0.016 cm vs. 0.118 ± 0.009 cm) measurements were significantly higher in the ADHD group than in the control group. Additionally, partial correlation analyses revealed that a positive correlation was observed between IMT and EAT, and PAT measurements separately. Multivariate linear regression analysis revealed that, body mass index (BMI) positively predicted IMT. Also, age and BMI positively predicted the EAT levels of the subjects with ADHD. Conclusion: Our results suggest that children and adolescents with ADHD have a risk for cardiovascular disease. For this reason, subclinical atherosclerosis should be taken into consideration in the follow-up and treatment of ADHD for cardiovascular disease risk.

Quantification of periaortic adipose tissue in contrast-enhanced CT angiography: technical feasibility and methodological considerations.

To examine the feasibility of the quantification of abdominal periaortic fat tissue (PaFT) (tissue within - 45 to - 195 HU) in enhanced CT-angiographies compared to unenhanced CT-scans and identify methodological issues affecting its clinical implementation. Using OsirixMD, PaFT volume and mean HU value were retrospectively measured within a 5 mm periaortic ring in paired unenhanced and enhanced abdominal aortic CT-scans. The correlation between PaFT values was examined in a derivation cohort (n = 101) and linear regression analysis produced correction factors to convert values from enhanced into values from unenhanced CTs. The conversion factors were then applied to enhanced CTs in a different validation cohort (n = 47) and agreement of corrected enhanced values with values from unenhanced scans was evaluated. Correlation between PaFT Volume und Mean HU from enhanced and unenhanced scans was very high (r > 0.99 and r = 0.95, respectively, p < 0.0001 for both). The correction factors for PaFT Volume and Mean HU were 1.1057 and 1.0011. Potential confounding factors (CT-kilovoltage, slice thickness, mean intraluminal contrast density, aortic wall calcification, longitudinal variation of intraluminal contrast density, aortic diameter) showed no significant effect in a multivariate regression analysis (p > 0.05). Bland-Altman analysis of corrected enhanced and unenhanced values showed excellent agreement and Passing-Bablok regression confirmed minimal/no residual bias. PaFT can be quantified in enhanced CT-angiographies very reliably. PaFT Volume scores are very consistently slightly underestimated in enhanced scans by about 10%, while the PaFT Mean HU value remains practically constant and offers distinct methodological advantages. However, a number of methodological issues remain to be addressed.