Numerical reconstruction of pulsatile blood ow 4D computer tomography data

We present a novel numerical algorithm developed to reconstuct pulsatile blood ow from ECG-gated CT angiography data. A block-based optimiza- tion method was constructed to solve the inverse problem corresponding to the Riccati-type ordinary di�erential equation that can be deduced from conserva- tion principles and Hook's law. Local ow rate for 5 patients was computed in 10 cm long aorta segments that are located 1 cm below the heart. The shapes of the local ow rate curves seem to be very realistic. Our approach is suitable for estimating characteristics of pulsatile blood ow in aorta based on ECG gated CT scan thereby contributing to more accurate description of several cardiovascular lesions

Fiatalkori iliofemoralis mélyvénás thrombosis ritka oka: tünetmentes vena cava inferior elzáródás

INTRODUCTION: Acute lower extremity deep venous thrombosis in young adults is usually related to thrombophilia, immobility, trauma, surgery or malignancy. Therapeutic options have recently included pharmacomechanical thrombus removal although there is no evidence of the indication or of the long-term benefit. Rarely unknown, asymptomatic chronic neonatal inferior vena cava occlusion could also lead to acute ilio-femoral thrombosis. AIM: The aim of the authors was to present the therapeutic possibilities in lower extremity deep venous thrombosis connected with chronic inferior vena cava occlusion. METHOD: In a retrospective single center study data of 21 adults were analyzed. RESULTS: In 4 of the 21 patients chronic inferior vena cava obstruction was identified as an underlying cause of the acute thrombosis. Pharmacomechanical lysis was not offered to them and anticoagulation therapy was introduced. After an average 27.5 +/- 11 month follow-up all the patients were alive and no adverse event occurred. CONCLUSIONS: In patients with acute lower extremity deep venous thrombosis and chronic inferior vena cava occlusion the indication of the endovenous pharmacomechanical lysis therapy is questionable. The authors suggest to consider computed tomography angiography or magnetic resonance angiography in addition to duplex sonography in patients with no obvious risk factors for lower extremity deep venous thrombosis to avoid unnecessary invasive treatment. Orv. Hetil., 2016, 157(34), 1361-1365

Thoracic aortic strain can affect endograft sizing in young patients

Aortic computed tomography angiography (CTA) examination with electrocardiography gating is becoming the clinical routine image acquisition protocol for diagnosis and intervention planning. To minimize motion artifact, the images are reconstructed in the diastolic phase of the cardiac cycle. The aim of our study was to quantify aortic strain in an elderly nonaneurysmatic patient cohort and to identify the phases of the R-R cycle that correspond to the minimal and maximal aortic diameters. The quantification of aortic strain may enable the improvement of intervention planning and the introduction of more effective dose-saving protocols for CTA scans. Methods: We assessed CTA images of 28 patients (14 men; mean age, 74 years). Aortic calcium score was calculated on native images. Angiography images were reconstructed in equally spaced 10 phases of the R-R cycle. After semiautomatic centerline analysis, we measured the cross-sectional areas in each of the 10 phases at 9 specific segments between the ascending aorta and the common iliac bifurcation representing the attachment sites of thoracic and abdominal stent grafts. Area-derived effective diameter, pulsatility (Amax L Amin), and strain [(Amax L Amin)/Amin] were calculated. Repeated measurements were taken to evaluate inter-reader and intrareader reproducibility (10-10 patients each). Results: A total of 4320 measurements were performed. We found significant difference between diastolic and systolic diameters (DD,Z0 [ 33.2, DS,Z0 [ 34.4; P < .001). Pulsatility values of the vessel diameters were 1.0 to 1.1 mm in the thoracic aorta, 0.7 to 0.9 mm in the abdominal aorta, and 0.5 to 0.6 mm in the common iliac arteries. Negative, moderate correlations were found between aortic strain and age (r [ L0.586; P [ .001), aortic strain and plaque area (r [ L0.429; P [ .026), and age and body mass index (r [ L0.412; P [ .029). We found positive, moderate correlation between age and plaque area (r[0.594; P[.001). The aortic pulsatility curve has a positive extreme at 30% and a negative extreme at 90% of the R-R cycle throughout the aorta. Lin concordance coefficients were 0.987 for inter-reader and 0.994 for intrareader correlations. Conclusions: Aortic strain can be reliably quantified on electrocardiography-gated CTA images. Pulsatility of the aorta can be substantial in the thoracic aortic segments of young patients; therefore, the routine use of systolic images is not recommended. In addition, we demonstrated that images at 30% of the heart cycle correspond to the largest diameter of the aorta

Freezing motions of the intimal flap after acute aortic dissection with ECG-gated CT angiography

CT angiography is the gold standard imaging modality in acute aortic dissection. Recent achievements in technology made image acquisition quick enough for the ECG-gated angiography of the whole aorta during one breath-hold. Latest versions of iterative image reconstruction algorithms and low-noise x-ray detectors resulted in significant dose and/or image noise reduction, both being comparable to conventional non-ECG-gated scans (1). This huge progression in non-invasive diagnostic testing allows us to clearly visualize the undulating intimal flap in acute aortic dissection and to accurately assess side-branch involvement and ostial anatomy (2). Understanding the motion characteristics of the intimal septum is fundamental in the planning of targeted interventions which can lead to better prognosis. In this collage, we demonstrate the typical patterns of intimomedial membrane motion at those specific levels of the thoracic and abdominal aorta requiring special attention when evaluating acute aortic dissection with ECG-gated CT angiography

Pitfalls of delaying the diagnosis of hereditary haemorrhagic telangiectasia

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Komplex endovascularis rekonstrukciók az aortaíven : műtéti esetbemutatások

Az aortaívet érintő aortabetegségek miatt végzett endovascularis rekonstrukciók (thoracic endovascular aneurysm repair – TEVAR) során a sztentgraft proximalis rögzítése az ívben vagy az aorta ascendensen van. Ilyen esetben hagyományosan nyitott műtéttel előzetesen biztosítjuk a lefedésre kerülő supraaorticus ágak keringését (ún. ’de branching’ műtétek). Nyitott műtétre nem alkalmas betegek esetén azonban az ágak endovascularis módszerekkel történő megtartására kényszerülünk. Tanulmányunkban ezen komplex endovascularis aortaívrekonstrukciók lehető ségeit mutatjuk be. A párhuzamos graftokat jellemzően sürgősségi körülmények között alkalmazzuk. Az ascendensen történő proximalis rögzítés esetén a jobb arteria (a.) carotisról indított ’debranching’ és a truncus brachiocephalicus párhuzamos grafttal történő biztosításával kombinált hibrid műtétet végeztünk. Létfontosságú ér véletlen lefedésével járó TEVAR esetén sürgősséggel végezhetünk konverziót például a bal a. carotis communis keringésének gyors hely reállítására. A bal a. subclavia előzetes revascularisatiója nélkül végzett sürgősségi TEVAR után ritkán jelentkező bal felső végtagi ischaemia esetén utólagos konverziót végezhetünk a bal a. subclavia lumenének helyreállítására ugyan csak párhuzamos grafttal. A kisgörbületen elhelyezkedő, saccularis morfológiájú penetráló aortafekélyek sikeres kirekesztését segítheti egyedi gyártású graft alkalmazása, melyen a nagygörbületen lévő supraaorticus érszájadék köré kivágást, ún. ’scallop’ot helyezünk a graft proximalis végéhez, megnövelve így a proximalis nyak hosszát. Elektív körülmények között ugyancsak egyedileg gyártott elágazó graftot is alkalmazhatunk, melynek során akár mindhárom ág megtartható az ascendensről induló proximalis rögzítés mellett, így arra alkalmas anatómia esetén endovascularis ívcserére is lehetőségünk van

Neutrophil-to-Lymphocyte Ratio Is an Independent Risk Factor for Coronary Artery Disease in Central Obesity

Several inflammatory biomarkers were found to be associated with an increased risk of cardiovascular disease. Neutrophil-to-lymphocyte ratio (NLR) is a marker of subclinical inflammation that increases with the stress response. Visceral adiposity index (VAI) calculated as a combination of anthropometric and metabolic parameters reflects both the extent and function of visceral adipose tissue. Given the association of subclinical inflammation with both obesity and cardiovascular diseases, it is plausible that the inflammation-CVD association is modulated by the amount and function of adipose tissue. Thus, our aim was to examine the association between NLR and coronary artery calcium score (CACS), an intermediate marker of coronary artery disease in asymptomatic patients across VAI tertiles. Methods: Data from 280 asymptomatic participants of a cardiovascular screening program were analysed. In addition to the collection of lifestyle and medical history, a non-contrast cardiac CT scan and laboratory tests were performed on all participants. Multivariate logistic regression was conducted with CACS > 100 as the outcome and with conventional cardiovascular risk factors and NLR, VAI, and NLR by VAI tertile as predictors. Results: We found an interaction between VAI tertiles and NLR; NLR values were similar in the lower VAI tertiles, while they were higher in the CACS > 100 in the 3rd VAI tertile (CACS ≤ 100: 1.94 ± 0.58 vs. CACS > 100: 2.48 ± 1.1, p = 0.008). According to multivariable logistic regression, the interaction between NLR and VAI tertiles remained: NLR was associated with CACS > 100 in the 3rd VAI tertile (OR = 1.67, 95% CI 1.06-2.62, p = 0.03) but not in the lower tertiles even after adjustment for age, sex, smoking, history of hypertension, hyperlipidaemia, and diabetes mellitus, as well as high-sensitivity C-reactive protein. Our findings draw attention to the independent association between subclinical, chronic, systemic inflammation and subclinical coronary disease in obesity