Misako Iino

Sensitivity and specificity of CT in the diagnosis of inflammatory abdominal aortic aneurysms.

Purpose The purpose of this study is to assess the diagnostic ability (sensitivity and specificity) of CT in the diagnosis of inflammatory abdominal aortic aneurysm (IAAA) and to quantitatively evaluate its features. Method A retrospective survey of 355 consecutive patients with abdominal aortic aneurysm and iliac artery aneurysm who underwent CT examination and surgical repair yielded 18 patients with operatively confirmed IAAA. The sensitivity, specificity, and diagnostic accuracy of CT were evaluated in this review. Eighteen IAAAs were then analyzed in terms of distribution and degree of perianeurysmal fibrosis as well as time-dependent change of CT values of the aneurysmal wall on contrast-enhanced CT. Complications related to IAAA were also determined. Results Fifteen of the 18 cases of IAAA could be easily diagnosed on CT prior to surgical repair. Three false-negative and one false-positive case were found. This gives a sensitivity rate of 83.3% for this imaging technique, with specificity and accuracy rates of 99.7 and 93.7%, respectively. Thickening of the aortic wall was noticed mostly in the anterolateral wall of the aneurysm as compared with the posterior wall. The thickness of the perianeurysmal fibrosis correlated neither with the size of aneurysm nor with the inflammatory reaction such as erythrocyte sedimentation rate, C-reactive protein level, and white blood cell count. CT indicated the complications in 7 of 18 patients with IAAA. These included hydronephrosis, aortoenteric fistula, and infected iliac aneurysm. Conclusion CT scan with contrast enhancement was a highly reliable imaging modality for the diagnosis of IAAA.

One-Year Follow-Up and Convalescence Evaluated by Nuclear Medicine Studies and 24-Hour Holter Electrocardiogram in 11 Patients With Myocardial Injury Due to a Blunt Chest Trauma

BACKGROUND There are few reports on long-term convalescence with regard to cardiac injury caused by blunt chest trauma. Nuclear medicine study of the heart (NMSH) in the early stages of injury is reportedly superior to detect the correlation between injury and fatal arrhythmia. Therefore, we prospectively performed NMSH and Holter electrocardiogram (ECG) in the early and chronic stages for a cardiac injury patient, and we longitudinally examined the recovery process and the occurrence of fatal arrhythmia. METHODS AND RESULTS A total of 202 patients with blunt chest trauma were admitted to our hospital between April 2006 and January 2007. Of 65 patients who were diagnosed with cardiac injury by ECG, a myocardial enzyme, or cardiac ultrasonography, 11 were enrolled in this study because they agreed to outpatient visiting for regular examinations for 1 year. NMSH showed positive findings in 6 of the 11 patients in the acute period of <1 month. Twelve months later, five patients improved but still exhibited protracted cardiac damage without complete recovery. Among the six patients in whom NMSH showed positive findings, Holter ECG indicated an abnormal finding in two patients in the acute period and in four patients in the chronic period, and detected one patient with a nonsustained ventricular tachycardia in the chronic period. CONCLUSION Cardiac injuries may exacerbate cardiac functions and lead to fatal arrhythmia during the chronic period. Therefore, evaluating recovery for at least 12 months after myocardial damage is necessary to prevent sudden cardiac death.

A case of right renal artery originating from the thoracic aorta

The renal arteries normally originate from the abdominal aorta between the first and second lumbar vertebrae. The main renal artery arising from the thoracic aorta is an uncommon anomaly. Here we report a rare case of a right renal artery originating above the celiac axis. A 38-year-old male underwent computed tomographic angiography in preparation for being a renal donor, and two right renal arteries were observed. A main renal artery arose from the thoracic aorta at the 11th thoracic vertebral level, and an accessory renal artery originated from the abdominal aorta at the renal hilum.

A case of right double inferior vena cava with circumcaval ureter

Congenital inferior vena cava (IVC) anomalies are silent and detected incidentally on imaging. Double IVC is the most common IVC anomaly and is usually characterized by the presence of an IVC on each side of the abdominal aorta. In contrast, right double IVC, which is defined as two post-renal IVCs positioned to the right of the abdominal aorta, is seldom recognized. We report a rare case of a complete right double IVC with a circumcaval ureter that was incidentally detected by CT and describe the embryological and clinical implications.

Congenital pericardial defect: a case of right pericardial partial absence with normal partial pleura

Congenital pericardial defect (CPD) is a rare cardiovascular anomaly. A right-sided CPD is much rarer than left-sided defects. Usually both the pericardium and parietal pleura are absent. We report a rare case of a right partial CPD involving the right atrial appendage, suspected by computed tomography and cine magnetic resonance imaging, and confirmed by thoracoscopy, which also demonstrated a normal parietal pleura.

High-resolution imaging of complex aortic plaques in ischemic stroke patients using 3.0 Tesla MRI with VISTA

Complex aortic plaques (CAP) in the thoracic aorta are considered a recurrent risk factor of ischemic stroke in association with instability [1]. Magnetic resonance (MR) plaque imaging of CAP in the thoracic aorta, using black blood imaging by the conventional double inversion recovery (DIR) method has not been challenging due to motion artifacts from cardiac pulsation. This study tried to evaluate the quality of CAP using MR plaque imaging with a new method. The present study was a prospective study and the participants were selected involving acute ischemic stroke patients admitted to Tokai University Hospital between October 2013 and September 2014. Written informed consent was obtained from all patients. This study was approved by the Tokai University Ethics Committee (13R-118). Ten acute ischemic stroke patients where aortic arch plaque was detected with transesophageal echocardiography (TEE) were recruited (age median, 76 years [interquartile range (IQR), 65–80 years], 5 were women [50%]). All recruited patients were classified as stroke of other determined etiology based on the diagnosis of clinical subtype made by an experienced neurologist according to the Trial of Org 10172 in the Acute Stroke Treatment classification [2]. Regarding vessel wall analysis of the aorta with plaque imaging, evaluation revealed CAP using MR imaging (MRI) and TEE. MRI was performed using 3.0 Tesla MRI (Achieva 3.0T; Philips Healthcare, Andover, MA, USA). All cases underwent T1 black blood imaging by a new sequence of volume isotropic TSE acquisition (VISTA) [3]. We measured the consecutive thoracic aorta on the coronal view by synchronizing with heartbeats of the maximal systolic phase to reduce flow artifacts. Upon imaging, the scan time/parameters were standardized across all patients. Aortic vessel wall were verified and results were compared with TEE findings. TEE was performed using ARTIDA (TOSIBA, Japan) with a 5 MHz, multiplane probe. Aortic plaques were evaluated from the ascending aorta to the aortic arch. Evaluation included plaques in the short axial view for maximal plaque thickness, low echoic lesion, mobility, and ulcerative lesion. An ulcerative lesion was defined as the presence of surface defects showing a depth of over 2.0 mm. Based on the MRI findings, patients were divided into the following two groups: positive or negative findings of high signal resolution along the vessel wall, following the previous reports (Fig. 1) [3, 4]. Evaluation included correlations with age, sex, atherosclerotic risk factors (hypertension, diabetes mellitus, and dyslipidemia), inflammatory marker (high sensitivity C-reactive protein [hsCRP]), and high the Calcification in the Aortic Arch, Age, Multiple Infarction (CAM) score (≥ 3) [5]. High signal resolution was detected along the thoracic aorta wall in 5 patients (positive group). Age, sex, and atherosclerotic risk factors were not significantly different between the positive group and negative group. Low echoic lesion (4 [80%] vs. 1 [20%], respectively, p = 0.06) and ulcerated/mobile lesion (2 [20%] vs. 0 [0%], respectively) of TEE were detected at a higher frequency in the positive group compared to the negative group, which is in agreement with the high signal resolution. The median plaque thickness was not significantly different between the positive and negative group (5 [4–6; IQR] vs. 4 [3–6], respectively). Hs-CRP was also significantly higher in the positive group than in