Sasan Partovi

Correlation of Carotid Artery Atherosclerotic Lesion Echogenicity and Severity at Standard US with Intraplaque Neovascularization Detected at Contrast-enhanced US

PURPOSEnTo correlate echogenicity and severity of atherosclerotic carotid artery lesions at standard ultrasonography (US) with the degree of intraplaque neovascularization at contrast material-enhanced (CE) US.nnnMATERIALS AND METHODSnThis HIPAA-compliant study was approved by the local ethics committee, and all patients provided informed consent. A total of 175 patients (113 [65%] men, 62 [35%] women; mean age, 67 years ± 10 [standard deviation]) underwent standard and CE US of the carotid artery. Lesion echogenicity (class I to IV), degree of stenosis, and maximal lesion thickness were evaluated for each documented atherosclerotic lesion. The degree of intraplaque neovascularization at CE US was categorized as absent (grade 1), moderate (grade 2), or extensive (grade 3). Correlation of neovascularization with echogenicity, degree of stenosis, and maximal lesion thickness was made by using Spearman ρ and χ(2) test for trend.nnnRESULTSnIn a total of 293 atherosclerotic lesions, echogenicity was inversely correlated with grade of intraplaque neovascularization (ρ = -0.199, P < .001). More echolucent lesions had a higher degree of neovascularization compared with more echogenic ones (P < .001). The degree of stenosis was significantly correlated with grade of intraplaque neovascularization (ρ = 0.157, P = .003). Lesions with higher degree of stenosis had higher grade of neovascularization (P = .008), and maximal lesion thickness increased with the grade of neovascularization (P < .001) and was significantly correlated with grade of neovascularization (ρ = 0.233, P < .001).nnnCONCLUSIONnNeovascularization visualized with CE US correlates with lesion severity and with morphologic features of plaque instability, contributing to the concept that more vulnerable plaques are more likely to have a greater degree of neovascularization. Therefore, CE US may be a valuable tool for further risk stratification of echolucent atherosclerotic lesions and carotid artery stenosis of different degrees.nnnSUPPLEMENTAL MATERIALnhttp://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10101008/-/DC1.

Contrast-enhanced ultrasound for assessing carotid atherosclerotic plaque lesions

OBJECTIVEnContrast-enhanced ultrasound that is used to assess atherosclerotic carotid plaques improves visualization of vessel wall irregularities and provides direct visualization of intraplaque neovascularization. This article illustrates the use of contrast-enhanced ultrasound in the assessment of carotid atherosclerotic lesions.nnnCONCLUSIONnContrast-enhanced ultrasound is a new, noninvasive, and safe procedure for imaging carotid atherosclerotic lesions. It is a valuable tool for evaluating the vulnerable plaque at risk for rupture and for evaluating both the development and severity of systemic atherosclerotic disease.

Integration of the computational fluid dynamics technique with MRI in aortic dissections

Short‐term and long‐term prognosis and their determining factors of Type III/Stanford B aortic dissections (TB‐AD), which separate the aorta distal at the origin of the subclavian artery into a true lumen and false lumen, have been elusive: One quarter of patients thought to be treated successfully, either by medical or by surgical means, do not survive 3 years. Unfavorable hemodynamic conditions are believed to lead to false lumen pressure increases and complications. A better characterization of TB‐AD hemodynamics may therefore impact therapeutic decision making and improve outcome. The large variations in TB‐AD morphology and hemodynamics favor a patient‐specific approach. Magnetic resonance imaging with its capability to provide high‐resolution structural images of the lumen and aortic wall and also to quantify aortic flow and kinetics of an exogenous tracer is a promising clinical modality for developing a deeper understanding of TB‐AD hemodynamics in an individual patient. With the information obtained with magnetic resonance imaging, computational fluid dynamics simulations can be performed to augment the image information. Here, an overview of the interplay of magnetic resonance imaging and computational fluid dynamics techniques is given illustrating the synergy of these two approaches toward a comprehensive morphological and hemodynamic characterization of TB‐AD. Magn Reson Med, 2013.

Bloodless Lung Transplantation in Jehovah's Witnesses: Impact on Perioperative Parameters and Outcome Compared With a Matched Control Group

BACKGROUNDnJehovahs Witnesses (JW) refuse to receive blood products due to their religious beliefs. Bloodless transplantation programs have made the successful transplantation of solid organs like heart, liver, kidney, and pancreas in JW feasible. In this study we present the third and fourth case of a successful bloodless lung transplantation and analyze perioperative parameters and outcome with a strictly selected matched control group (CG).nnnMETHODSnTwo JW patients suffering from idiopathic pulmonary fibrosis had single lung transplantation in the transfusion-free program. Ten of 113 patients (8.8%) undergoing lung transplantation fulfilled the matching criteria and served as CG. Perioperative parameters including blood loss and transfusions were collected from the charts. Regarding outcome parameters arterial blood gas, lung function testing, length of stay, and survival were analyzed.nnnRESULTSnConcerning perioperative parameters no significant differences could be found between both groups except for the creatinine level, which was significantly lower in the JW group on postoperative day 0 (P = .037), and the hemoglobin and hematocrit levels, which were significantly higher in the JW group on postoperative day 3 (P = .032 and P = .041, respectively). The analysis of the outcome parameters revealed significantly higher postoperative lung functional testing values forced expiratory volume after 1 second (FEV1) and forced vital capacity (FVC) in the JW group compared with the CG (P = .037 and P = .036, respectively).nnnCONCLUSIONnBloodless lung transplantation is feasible in carefully selected JW recipients. Comparing JW to CG, no statistically significant difference in the perioperative course and a trend towards a favorable postoperative lung function outcome were detected.

PET/MR in Colorectal Cancer

Colorectal cancer (CRC) is the third most common malignant neoplasm in mankind with slightly less than 1.2 million new cases and more than 600,000 deaths worldwide in 2008 [1, 2]. Colorectal cancer is frequently associated with metastatic disease – either synchronous or metachronous – with the highest number of metastases to the lymph nodes and liver. In CRC patients’ early detection of metastases has a strong impact on prognosis since effective interventional as weall as surgical treatment options can be offered leading to relatively high survival rates [3]. If disease course is followed closely with imaging, survival can be significantly improved [4].

Gadofosveset--a blood pool contrast agent used with MRI to detect obscure gastrointestinal bleeding: a case report.

Gadofosveset—A Blood Pool Contrast Agent Used with MRI to Detect Obscure Gastrointestinal Bleeding: A Case Report