FT17. Computed Tomography Evaluation of Adamkiewicz Artery in Patients With and Without Aortic Disease

Objective: Early detection of aortic degeneration is critical for improving outcomes in patients with aortic aneurysm and dissection. We investigated nanoparticle contrast-enhanced computed tomography for the early detection of aortic injury. Approach and Results: In a mouse model of sporadic aortic aneurysm and dissection, C57BL/6J mice were challenged with a high-fat diet and Ang II (angiotensin II) infusion (n=20). Unchallenged control mice received a standard laboratory diet and saline infusion (n=19). Computed tomography angiography (CTA) was performed to evaluate aortic enlargement, and delayed nanoparticle contrast-enhanced computed tomography (CTD) imaging was performed to detect wall signal enhancement indicative of aortic wall degeneration. Aortic segments that exhibited CTD findings but appeared normal on CTA were termed preclinical aortic disease. Aortic aneurysm and dissection development was determined upon the gross examination of excised aortas. Aortic degeneration and inflammation were examined by performing histological and immunofluorescence analyses. Leakage of Evans blue dye into aortic wall was used to validate changes in vascular permeability. In challenged mice, gross findings of aortic disease were found in 41% of aortic segments. CTA findings of mild disease (dilatation) and advanced disease (aortic aneurysm and dissection with the presence of false lumen) were seen in 33% of aortic segments. CTD findings of wall signal enhancement were seen in 63% of aortic segments. Of those, 48% appeared normal on CTA. Aortic segments with CTD findings showed aortic wall degeneration and inflammation on histological and immunofluorescence analyses. Immunofluorescence analysis and Evans blue dye uptake suggested passive leakage of nanoparticle contrast agent due to endothelial injury as a potential mechanism underlying the detection of aortic disease on CTD. Conclusions: In mice, CTD imaging exhibits high sensitivity for detecting aortic wall degeneration and inflammation before vessel enlargement becomes evident in CTA.

Download Full-text

Frank's sign with acute aortic dissection

10.22541/au.163846246.64225415/v1 ◽

2021 ◽

Author(s):

Hironobu Nishiori ◽

Yuichi Hirano ◽

Masayoshi Otsu ◽

Hiroyuki Watanabe

Keyword(s):

Computed Tomography ◽

Back Pain ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

Young Patients ◽

Type A ◽

Aortic Disease ◽

Atherosclerotic Disease ◽

Smoking History

A 59-year-old man with a long smoking history presented with sudden back pain. Frank’s sign was noticed in his bilateral ears, and computed tomography revealed Stanford type A acute aortic dissection. If young patients have Frank’s sign, attention should be paid to atherosclerotic disease including aortic disease.

Download Full-text

Computed tomography angiography findings of abdominal aortic disease: A review of emergencies

Medicinski pregled ◽

10.2298/mpns2012393j ◽

2020 ◽

Vol 73 (11-12) ◽

pp. 393-400

Author(s):

Mirela Jukovic ◽

Aleksandra Mijatovic ◽

Ivana Stojic ◽

Ljiljana Drazetin ◽

Maja Stankov ◽

...

Keyword(s):

Computed Tomography ◽

Abdominal Aorta ◽

Computed Tomography Angiography ◽

Clinical Manifestations ◽

Aortic Disease ◽

Occlusive Disease ◽

Tunica Media ◽

Abdominal Aortic ◽

Wide Range ◽

Life Threatening

Introduction. The aorta is a major blood vessel that supplies all segments of the human body. Acute aortic syndrome is a term that implies a life-threatening aortic disease. Due to the speed of examination and widespread availability, computed tomography angiography is a front-line diagnostic modality for emergencies and diseases of the abdominal aorta. The aim of this study was to provide a wide range of potentially life-threatening abnormalities of the abdominal aorta in daily clinical and radiological practice through a series of computed tomography angiography images and three-dimensional virtual reconstruction. Abdominal aortic aneurysm is defined as a 50% increase in diameter more than the normal arterial diameter. One of the most important complications of an aneurysm is a rupture that can be acute or chronic, presenting with various clinical manifestations. Aortic dissections are caused by abnormality of the tunica media layer, forming an intimal-medial flap and two types of lumen. A penetrating aortic ulcer may erode through the internal elastic lamina of the aortic wall and allow formation of hematoma within the tunica media. Occlusive disease of the abdominal aorta may refer to the late stage of chronic aortoiliac occlusive disease, whereas the acute and/or subacute form occurs due to sudden thrombosis or occlusion. Conclusion. The recognition of specific radiological signs of abdominal aortic disease using computed tomography angiography contributes to optimal treatment of patients and reduces mortality.

Download Full-text

Thoracic aortic disease: Spectrum of multidetector computed tomography imaging findings

Journal of Cardiovascular Computed Tomography ◽

10.1016/j.jcct.2007.04.003 ◽

2007 ◽

Vol 1 (1) ◽

pp. 40-54 ◽

Cited By ~ 16

Author(s):

Suhny Abbara ◽

Sanjeeva Kalva ◽

Ricardo C. Cury ◽

Eric M. Isselbacher

Keyword(s):

Computed Tomography ◽

Multidetector Computed Tomography ◽

Aortic Disease ◽

Imaging Findings ◽

Computed Tomography Imaging ◽

Thoracic Aortic Disease ◽

Tomography Imaging ◽

Disease Spectrum

Download Full-text

Computed Tomography Imaging in Aortic Dissection

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.5.42531 ◽

2019 ◽

Vol 3 (3) ◽

pp. 316-317

Author(s):

AmandaH. Westfall ◽

John Garrett

Keyword(s):

Computed Tomography ◽

Ct Angiography ◽

Aortic Disease ◽

Computed Tomography Imaging ◽

Coronary Ct ◽

Pulmonary Angiogram ◽

High Clinical Suspicion ◽

Triple Rule Out ◽

Ct Pulmonary Angiogram ◽

Rule Out

Emergency physicians often rely on a “triple-rule-out” computed tomography (CT) where image acquisition is timed to obtain image quality equivalent to dedicated coronary CT angiography, pulmonary CT angiography, and thoracic aorta CT angiography. This case highlights the importance of obtaining CT angiography dedicated to the aorta in the setting of high clinical suspicion for aortic disease if initial CT pulmonary angiogram is negative for aortic disease.

Download Full-text

Routine preoperative aortic computed tomography angiography is associated with reduced risk of stroke in coronary artery bypass grafting: a propensity-matched analysis

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz237 ◽

2019 ◽

Author(s):

Sigrid E Sandner ◽

Richard Nolz ◽

Christian Loewe ◽

Mariella Gregorich ◽

Georg Heinze ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Propensity Score ◽

Coronary Artery Bypass ◽

Computed Tomography Angiography ◽

Artery Bypass ◽

Aortic Disease ◽

Bypass Grafting ◽

Reduced Risk

Abstract OBJECTIVES The aim of this study was to determine stroke rates in patients who did or did not undergo routine computed tomography angiography (CTA) aortic imaging before isolated coronary artery bypass grafting (CABG). METHODS We conducted a retrospective analysis of a prospectively maintained single-centre registry. Between 2009 and 2016, a total of 2320 consecutive patients who underwent isolated CABG at our institution were identified. Propensity score matching was used to create a paired cohort of patients with similar baseline characteristics who did (CTA cohort) or did not (non-CTA cohort) undergo preoperative aortic CTA. The primary end point of the analysis was in-hospital stroke. RESULTS In 435 propensity score-matched pairs, stroke occurred in 4 patients (0.92%) in the CTA cohort and in 14 patients (3.22%) in the non-CTA cohort (P = 0.017). Routine preoperative aortic CTA was associated with a significantly reduced risk of in-hospital stroke [relative risk 0.29, 95% confidence interval (CI) 0.09–0.86; P = 0.026; absolute risk reduction 2.3%, 95% CI 0.4–4.2; P = 0.017; number needed to treat = 44, 95% CI 24–242]. CONCLUSIONS A preoperative screening for atheromatous aortic disease using CTA is associated with reduced risk of stroke after CABG. The routine use of preoperative aortic CTA could be applied so that surgical manipulation of the ascending aorta can be selectively reduced or avoided in patients with atheromatous aortic disease.

Download Full-text