Nobuhiro Morooka

Evaluation of morphological changes of the atherosclerotic aorta by enhanced computed tomography

Enhanced and non-enhanced computed tomography (CT) were performed in 405 subjects (222 men; 183 women; mean age 57 years). Intimal atherosclerotic changes of the aorta were quantified by enhanced CT, revealing the atheromatous intima to be projecting and thick-walled, while non-enhanced CT demonstrated aortic calcification. We measured the degree of aortic intimal changes at various segments of the aorta. In 224 cases, CT was performed from the aortic root to the bifurcation of the abdominal aorta. Intimal changes were found predominantly at the aortic arch, the middle descending thoracic and the infrarenal abdominal aorta. As for the intimal changes, aortic calcification and aortic pulse wave velocity were significant atherosclerotic characteristics. The aortic diameter did not show a significant association with intimal change. Among the various atherosclerotic risk factors, intimal change was significantly associated with age, systolic blood pressure, serum total cholesterol and diabetes mellitus, whereas gender, diastolic blood pressure, relative weight and cigarette use were not significantly related. For coronary artery disease and arteriosclerosis obliterans, aortic intimal changes constituted a significant atherosclerotic feature. In cerebrovascular disease, however, aortic intimal change did not play a significant role.

Coronary artery calcification detected by CT: clinical significance and angiographic correlates.

Cardiac computed tomography (CT) to detect coronary calcification was performed on 161 patients undergoing coronary angiography for proven or suspected coronary artery disease. Among 108 patients in whom coronary calci fications was identified, 90% had significant coronary stenosis angiographically (>75% stenosis), and 80% of 121 patients with significant coronary stenosis showed calcification by CT. The relationship between the calcification site and the significance in stenosis of each vessel was determined. Calcification was present in 133 arteries among 205 stenotic coronary arteries (sensitivity = 65%) as compared with 59 of 439 entire arteries with normal coronary angiograms (specificity = 87%). In the younger age group the sensitivity of calcification for stenosis of each coronary artery was lower and the specificity and predictive value were generally higher than those in the elderly group. These results demonstrate that CT is a valuable procedure for detecting coronary arterial disease, since this examination is easy to conduct, noninvasive, and widely applicable for screeening a large population.

ECG synchronized computed tomography in clinical evaluation of total and regional cardiac motion: Comparison of postmyocardial infarction to normal hearts by rapid sequential imaging

Computed tomograph (CT) of the heart was performed using the JEOL Dynamic Scanner, which provides CT cardiac images with minimal radiation and within a short period of time. ECG-synchronized CT was undertaken at various phases of the cardiac cycle every 0.04 second. Approximately 30 minutes of scanning was necessary to obtain a series of CT images of one complete cardiac cycle. In contract to 24 normal subjects, 38 patients with recent or remote myocardial infarction (MI) demonstrated hypokinetic, akinetic, or paradoxical movement of the ventricular segment corresponding to the MI sites predicted by ECG. The sequential cardiac area curve was useful in evaluating instantaneous changes of cardiac dimension, extent of ventricular contraction, and regional dyssynergy. ECG-synchronized CT studies using Somatom contrast dye enhancement in selected patients allowed sequential assessment of left ventricular cavity size and wall motion.

A case with dissecting aneurysm of the ascending aorta (DeBakey type II) survived long years after the onset.

症例は76才女性. 1978年胸部大動脈瘤を指摘され, 1983年同部解離性大動脈瘤の診断をうけ,降圧療法による治療を行っていた. 1988年,膵癌の第4胸椎への転移による両下肢麻痺が出現し,当科に入院したが,呼吸器感染症にて死亡.剖検にて,内部の器質化した直径10数cmのDeBakey II型解離性大動脈瘤を認めた.中枢型解離性大動脈瘤の予後は不良で,本症例のように瘤拡大の著明な例で,手術なしで長期間生存した例はまれであるため,ここに報告する.