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[Influence of systolic left ventricular blood flow direction on genesis of senile calcification of the aortic valve].

To assess the factors which may initiate and accelerate degenerative senile calcification of the aortic valve, two-dimensional echocardiograms and the clinical characteristics of 259 consecutive cases with senile calcification of the aortic valve were studied. The results were compared with those of similar studies among 186 consecutive cases with the normal aortic valves. An aortic cusp with an area of increased echo greater than 3 mm in width and with decreased pliability was regarded as calcified. Among patients with calcification of one aortic cusp, 114 exhibited calcification of a noncoronary cusp, 17 calcification of the left coronary cusp and 3 calcification of the right coronary cusp (p < 0.001). Among patients with calcification of 2 aortic cusps, 39 had calcification of a noncoronary and left coronary cusps, 3 calcification of the left and right coronary cusps and 16 calcification of the right and noncoronary cusps (p < 0.001). In patients with calcification of their aortic valves, the end-diastolic angle between the interventricular septum and the ascending aorta was 102 +/- 10 degrees; whereas, it was 89 +/- 10 degrees in the control group (p < 0.001). There were no differences in frequency of aortic root calcification, mitral annular calcification, hypertension, ischemic heart disease, hyperlipidemia, hyperuricemia, or hyperglycemia, between patients with and without calcification of their aortic valves. Of the female patients ranging in age from 65 to 74 years, 88% in those with calcification of 3 cusps and 30% in those with calcification of one cusp (p < 0.05) had mitral annular calcification.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Patterns of mammographically detected calcifications after breast-conserving therapy associated with tumor recurrence.

BACKGROUND: Some authors have suggested that mammographically evident calcifications that would be considered benign in other situations can be due to carcinoma in women who have undergone breast conservation. This study was undertaken to determine if the pattern of calcifications associated with recurrent tumors detected mammographically differs from that observed in carcinomas developing de novo. METHODS: Mammograms of 22 cases of local tumor recurrence were retrospectively reviewed, and calcifications associated with recurrence were characterized according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) classification. RESULTS: Tumors were usually associated with > or = 10 calcifications (77%; 17 of 22 cases). Recurrences commonly contained very suspicious patterns of calcifications with linear forms present in 15 cases (68%) and pleomorphic calcifications present in 17 cases (77%). The distribution of calcifications was usually clustered (73%; 16 of 22 cases) or segmental (18%; 4 of 22 cases). Recurrences were usually obviously malignant (BI-RADS Category 5), and were characterized as such in 77% of cases. The remainder were indeterminate, requiring biopsy (BI-RADS Category 4). Recurrent tumors containing calcifications always contained some suspicious forms. Less worrisome types of calcifications were sometimes observed, including punctate calcifications in 36% and coarse calcifications in 14% of cases, but were always associated with more malignant patterns. CONCLUSIONS: Local tumor recurrences, when associated with mammographically evident calcifications, usually have a pattern highly suspicious for malignancy, although indeterminate forms can be the only calcifications present. Characteristically benign patterns of calcifications are not observed in recurrent tumors unless they are associated with more suspicious calcifications. Therefore, women without more worrisome patterns need not undergo biopsy because of the presence of these nonworrisome calcifications.

Breast Diseases↗

Is pre-intervention intravascular ultrasound necessary in evaluating target lesion calcification in patients undergoing transcatheter therapy?

To identify a subset of patients with a high probability of extensive calcification for further intravascular ultrasound (IVUS) examination, the frequency and extent of target lesion calcification as assessed by IVUS and its correlations with age, gender and risk factors as well as the value of angiography in identifying ultrasound calcification were analyzed in 88 patients undergoing balloon angioplasty for significant coronary atherosclerotic stenosis. The extent of calcification was semi-quantitatively graded as 0: no calcification; +: calcification arc < 90 degrees; ++: calcification arc from 90 degrees to 180 degrees; : calcification arc > 180 degrees. The distribution pattern of calcification was classified as superficial, deep or mixed. The results indicate: (1) the frequency of target lesion calcification was 38.6%, of which 52.9% showed a superficial pattern and 56.0% had a calcification arc < 90 degrees; and (2) only age was significantly associated with target lesion calcification in all of the patients. The frequency of calcification was remarkably higher in patients > or = 60 years old than in patients < or = 60 years old (61.9% vs 17.4%, p < 0.001); (3) among patients less than 60 years old, those with calcification had a higher average number of risk factors than those without; and (4) the total sensitivity of angiography in identifying ultrasound calcification was 43.6%, with a significantly higher sensitivity for calcification arc > 180 degrees and mixed pattern. In conclusion, pre-intervention IVUS may be necessary in patients > or = 60 years old and in those < 60 years old with more than two risk factors in selecting devices to optimize interventional strategies.

Age Factors↗

Peritoneal calcification: causes and distinguishing features on CT.

OBJECTIVE: We undertook this study to determine the causes of peritoneal calcification seen on CT and to investigate which CT features distinguish benign from malignant peritoneal calcification. MATERIALS AND METHODS: Seventeen patients with peritoneal calcification were identified through retrospective review of reports from 74765 abdominopelvic CT examinations performed during a 7-year period. We determined the cause of peritoneal calcification by examining medical and histopathologic records. Calcification morphology was classified as nodular or sheetlike on the basis of the consensus interpretation by two independent radiologists. The radiologists also recorded the presence or absence of associated soft-tissue components or lymph node calcification. The association between the CT findings and the cause of calcification was assessed using chi-square analysis. RESULTS: Peritoneal calcification was due to peritoneal dialysis (n = 4), prior peritonitis (n = 3), cryptogenic origin (n = 1), or peritoneal spread of ovarian carcinoma (n = 9). Sheet-like calcification was more common in patients with benign calcification (seven of eight patients) than in those with malignant calcification (two of nine patients, p < 0.05). Nodal calcification was seen only in patients with malignant calcification (five of nine patients vs none of eight, p < 0.05). CONCLUSION: Common causes of peritoneal calcification are dialysis, prior peritonitis, or ovarian cancer; sheetlike calcification indicates a benign cause, whereas associated lymph node calcification strongly suggests malignancy.

Adult↗

[Nonrheumatic calcification of the mitral valve in patients with stenotic calcified bicuspid aortic valve].

The pathogenesis of nonrheumatic calcification of the mitral valve was investigated by analyzing the clinical and echocardiographic characteristics of patients with mitral valvular calcification without any findings suggestive of rheumatic heart disease or infective endocarditis. Calcification of the mitral valve was observed in nine patients, who all had calcified stenotic (aortic valve area < 1 cm2) bicuspid aortic valve. Calcification of the mitral valve was localized to the basal portion of ventricular aspect of the anterior mitral leaflet and contiguous to that of the aortic valve. Mobility and thickness of the mitral leaflet was normal except for the calcified portion. Calcification of the mitral valve was not contiguous to posterior mitral annular calcification nor was related to direction of aortic regurgitant flow. In patients with calcified stenotic bicuspid aortic valve, calcification of the mitral valve was not associated with location of the two aortic cusps, aortic valve area, aortic valvular peak pressure gradient, direction of the left ventricular outflow, end-diastolic left ventricular outflow tract dimension, end-diastolic dimension of the aortic annulus, incidence of aortic regurgitation, calcification of the aortic arch, or risk factors of atherosclerosis. Six patients with mitral valvular calcification had aortic valve replacement. Preoperative coronary angiogram of these patients was normal. Calcification of the aortic valve was on the ventricular and aortic aspects. The calcification of the aortic valve, anterior mitral ring, or anterior mitral leaflet was not rheumatic in these six patients. Rheumatic disease, risk factors of atherosclerosis, mechanical stress by left ventricular outflow or aortic regurgitant flow, or mitral annular calcification did not appear to be related to mitral valvular calcification. The distribution of aortic and mitral valvular calcification suggested that the calcification of the mitral valve was due to progression of calcification of the bicuspid aortic valve.

Aged↗

[Botallo's duct calcification in children: radiologic findings].

INTRODUCTION: Calcification of the ductus and ligamentum Botalli with no cardio-respiratory symptoms is normally a sign of their closure. However, as the calcification can be associated with a patent duct or a ductal aneurysm, its presence must not be misinterpreted. The frequency and the different patterns of this calcification must be known, as well as is diagnostic relevance. It is also important to differentiate it from other types of upper mediastinal calcification. MATERIAL AND METHODS: Thirty-two cases of ducts Botalli calcification were collected over 16 years, during which time period 38,476 children (24,095 males, 14,381 females) were submitted to chest radiography. Patient populations were divided into the following age-groups: preterms-newborns; 2-3 months; 4-6 months; 7-12 months; 2-3 years; 4-6 years; 7-10 years; 11 years on. We studied the ductus Botalli according to the following parameters; conspicuity, location, size and shape of the calcification; prevalence of the radiographic finding in 1,000 patients by gender and age; persistence of the finding in follow-up examinations. RESULTS: The calcification was found in left mediastinal site at the posterior aspect of the 4-6th ribs, ranging 1-6 mm in length, and 1-4 mm in width. It had a round, comma-like or elongated shape. In all, 32 cases of ductal calcification (.83/1000) were found: 14 (44%) were in males (age range 7 months-12 years), 18 (56%) in females (age range 11 months-10 years). Age range analysis shows that the calcification is distributed more evenly in the male population with the highest number of calcified ducts (5 = 94/1000) found in the 4-6 year age group and a relative prevalence in the age group 7-12 months (2 cases = 1.05/1000). A marked prevalence is found in females 4-6 years old (11 cases = 3.8/1000). The duct calcification was an occasional finding during chest radiography for other, more severe conditions in 9 of 14 males and in 6 of 18 females. CONCLUSIONS: No data can be found in the literature on the frequency of ductus Botalli calcification at chest radiography: our results indicate it to be less than 1/1000 (.83/1000). We have found a prevalence of ductus calcification (1.25/1000) in females even though females are less numerous in our population. The ductal calcification is often associated with severe, mostly hematologic, diseases. We believe that the conspicuity of the calcification is due to its density more than to its shape and size. Literature data indicate that ductus calcification may still be visible 6 months to 8 years after its discovery: our results, although on a small series, confirm this observation. The clinical significance of the calcification is still unclear.

Calcinosis↗

Calcification of the interclinoid and petroclinoid ligaments of sella turcica: a radiographic study of the prevalence.

OBJECTIVES: The purpose of this study was to evaluate the prevalence of calcifications of the sella turcica, in particular, calcification of the interclinoid and petroclinoid ligaments (PCL). DESIGN: Radiographic analysis of preoperative cephalometric film images. SETTING AND SAMPLE POPULATION: Lateral cephlometric radiographs of 255 subjects presenting for orthodontic evaluation were reviewed. The number of subjects selected for this study was determined by power analysis. EXPERIMENTAL VARIABLE: Two calibrated raters reviewed cephalometric projections and scored the films using a standardized rating scale. OUTCOME MEASURE: The rating scale classified interclinoid ligaments (ICL) into one of four categories depending on the degree of calcification and PCLs as either, no calcification, partial or complete calcification. RESULTS: Of all subjects, calcification of the ICL ranged from 39% rated as more than half calcified to 8% completely calcified. Petroclinoid analysis revealed 67% with no calcification, 23% with partial calcification and 9% completely calcified. Spearman's correlations were computed between age and the degree of calcification and between the degree of calcification for these two ligaments with a significant association between age and degree of calcification in the PCL, r = 0.185 (p = 0.003) and a significant association between the degree of calcification in the petroclinoid and ICLs, r = 0.186 (p = 0.003). In addition, chi-squared tests demonstrated statistically significant associations between the presence of calcification in the PCL to the distribution of age (p = 0.041) and between the presence of calcification in the ICL to the distribution of age (p = 0.045). CONCLUSION: As calcification of these ligaments has suggestive associations with disease entities, their recognition as a variant of normal anatomy should be evaluated when assessing cephalometric radiographs.

Adolescent↗

Medial artery calcification in ESRD patients is associated with deposition of bone matrix proteins.

BACKGROUND: In non-ESRD patients, recent studies have demonstrated that the process of vascular calcification resembles developmental osteogenesis. Patients with ESRD are known to have excessive vascular calcification, but this has previously been attributed to the non-cell-mediated process of metastatic calcification. METHODS: To determine if the calcification observed in patients with ESRD is related to a cell-mediated process, we removed a piece of inferior epigastric artery at the time of renal transplant. Calcium content of the entire vessel was quantified with spiral computed tomography (CT). The vessel was then examined histologically for calcification and the presence of bone matrix proteins by immunohistochemistry, and medial and intimal thickness quantified by histomorphometry. These findings were correlated with demographic, clinical and laboratory values. RESULTS: The proximal inferior epigastric artery was obtained from 41 patients undergoing renal transplantation, but two were inadequate for histologic examination. Twenty-seven of the remaining vessels had no evidence of calcification by MacNeal's or Alizarin red pH 4.2 staining, five vessels had mild/moderate calcification, and seven had severe calcification, all in the medial layer. Calcification assessed histologically was closely correlated with calcification score as assessed by spiral CT, normalized for vessel weight (P=0.027). Positive immunostaining for the bone matrix proteins osteopontin, type I collagen, bone sialoprotein, and alkaline phosphatase was strongly correlated with calcification (all P < or = 0.001), as was a history of coronary artery disease (P < 0.001), and diabetes (P=0.034). The calcification score by spiral CT correlated with these same factors and the serum phosphorus and calcium x phosphorus product (P=0.032 and 0.037). The location of immunostaining for the bone proteins was strongly associated with the presence of calcification. However, positive immunostaining also was observed in association with disorganization of the vascular smooth muscle cells in the medial layer due to deposition of a matrix-like substance, prior to overt calcification. CONCLUSIONS: In patients with ESRD undergoing renal transplantation, vascular calcification of the medial layer of the inferior epigastric artery is common (44%), can be detected by spiral CT, and is associated with deposition of bone matrix proteins. This implies an active cell-mediated process, raising hope that directed intervention can arrest this process.

Adult↗

Phosphate-induced vascular calcification: role of pyrophosphate and osteopontin.

Hyperphosphatemia is thought to underlie medial vascular calcification in advanced renal failure, but calcification can occur in other conditions in the absence of hyperphosphatemia, indicating that additional factors are important. To identify these factors, a model of medial calcification in rat aorta in vitro was developed. Aortic rings from rats were incubated in serum-free medium for 9 d, and calcification was measured as incorporation of (45)Ca and confirmed by histology and x-ray diffraction. No calcification occurred in normal vessels despite elevated free Ca(2+) and PO(4)(3-) concentrations of 1.8 mM and 3.8 mM, respectively, but mechanical injury resulted in extensive calcification in the media. Co-incubation studies revealed that normal aortas produced a soluble inhibitor of calcification in injured vessels that was destroyed by alkaline phosphatase. Culture of normal aortas with alkaline phosphatase resulted in calcification of the elastic lamina identified as hydroxyapatite by x-ray diffraction. This effect of alkaline phosphatase was not due to dephosphorylation of osteopontin (OPN), and calcification was not increased in aortas from OPN-deficient mice. The inhibitor was identified as pyrophosphate on the basis of the calcification induced in aortas cultured with inorganic pyrophosphatase, the inhibition of calcification in injured aortas by pyrophosphate, and the production of inhibitory levels of pyrophosphate by normal aortas. No calcification occurred under any conditions at a normal PO(4)(3-) concentration. It is concluded that elevated concentrations of Ca(2+) and PO(4)(3-) are not sufficient for medial vascular calcification because of inhibition by pyrophosphate. Alkaline phosphatase can promote calcification by hydrolyzing pyrophosphate, but OPN is not an endogenous inhibitor of calcification in rat aorta.

Alkaline Phosphatase↗

Calcifications in ovary and endometrium and their neoplasms.

In this study, we investigated the role of hormones in the pathogenesis of calcifications in ovary and in endometrium and their neoplasms of the gynecologic tract and assessed the anatomic location and incidence of these calcifications. The study consists of three parts designed to investigate the pathogenesis, the location, and the incidence of calcifications in ovary and endometrium and their neoplasms. In the first part, 79 female guinea pigs were divided into 10 groups, and different hormones, given weekly for 12 months, were administered to the guinea pigs by group. A control group of 7 guinea pigs received sterile water. Calcifications developed in 5 of 7 guinea pigs treated with prolactin, 10 of 20 treated with human chorionic gonadotropin, 5 of 11 treated with estradiol, 3 of 7 treated with estrone, 1 of 6 treated with growth hormone, and 1 of 10 treated with testosterone; in 20 of the guinea pigs, the calcifications developed in the stroma of the endometrium, and in 5 guinea pigs, they developed in the ovary. The second part of the study consisted of an evaluation of the specific location of calcifications in 43 consecutive human surgical ovaries and endometria. Calcifications were seen only in the stroma in 100% of the ovarian serous adenofibroma specimens; in ovarian serous borderline neoplasms, the stroma contained 70 to 100% of the calcifications, and the epithelium had 0 to 30% of the calcifications. In ovarian serous carcinoma specimens, the calcifications were seen in the stroma in 50 to 60% of the cases, in the epithelium in 40% of the cases, and in areas of necrosis in 10% of the cases. The third part of the study was directed to determine the frequency of calcifications in ovarian lesions. We found that all cases of endosalpingiosis and ovarian low-grade serous carcinoma had calcifications, whereas 80% of the cases of serous borderline tumor had calcifications, and only 50% of the cases of ovarian high-grade serous carcinoma contained calcifications. The results of this study indicate that the majority of the calcifications in the ovary and the endometrium and their neoplasms are present in the stroma. This is most probably secondary to metabolic changes, which could be related to hormones and not caused by degenerative changes in epithelial cells.

Animals↗

[Observation of calcification of thyroid tumors determined by CR and CT].

Detection of calcification of the thyroid gland is very useful for the clinical diagnosis and therapy of thyroid cancer. In this study, we evaluated the usefulness of FCR (Fuji computed radiography) and CT by analyzing the correlation between the imaging findings of calcification and histological diagnosis. Fifty-one cases of follicular adenoma and 63 cases of differentiated carcinoma underwent FCR and CT. All cases undergoing operation received histological examination. Calcification was detected in 19.6% of follicular adenomas and in 46.0% of differentiated carcinomas by FCR, and 37.3% of follicular adenomas and in 63.5% of differentiated carcinomas by CT. Among cases without calcification on FCR, CT detected calcification in 26.7%. These differences between the results of FCR and CT were found in cases with small calcifications, low thyroid gland position and in whom differentiation between tracheal cartilage calcification and thyroid carcinoma calcification was difficult. In these cases, calcification was difficult to detect by FCR alone. Patients with follicular adenoma aged > or = 60 years showed a higher prevalence of calcification than younger patients. In cases of differentiated carcinoma, no relationship was seen between age and the prevalence of calcification. The classification of calcification shape by FCR showed that the majority of psammoma bodies, as well as sharp and irregular shapes, were found in differentiated carcinoma while round calcifications were found in follicular adenomas. On CT, calcification inside the tumor was found in 73.7% of follicular adenomas and in 92.5% of differentiated carcinomas. FCR and CT are more useful for the detection of calcification than conventional radiography and are of great value in screening for thyroid tumors.

Adolescent↗

Valvular calcification in hemodialysis patients randomized to calcium-based phosphorus binders or sevelamer.

BACKGROUND AND AIM OF THE STUDY: Valvular calcification is common in patients with end-stage renal disease, and is associated with an unfavorable prognosis. It was hypothesized that sevelamer, a non-calcium-based phosphorus binder, might attenuate the progression of valvular calcification. METHODS: Two hundred subjects on maintenance hemodialysis received either sevelamer or calcium-based phosphorus binders. To assess the extent of calcification, 186 subjects underwent baseline electron beam tomography (EBT) of the coronary arteries, aorta and mitral and aortic valves, and 132 had follow up EBT scans at week 52. Changes in valvular calcification and combined valvular/vascular calcification were monitored and compared. RESULTS: At baseline, mitral valve calcification was seen in 46% of subjects, aortic valve calcification in 33%. Most subjects with zero values at baseline failed to progress over one year. Aortic valve calcification was significantly increased in calcium-treated subjects. Changes in mitral valve calcification, and combined mitral + aortic valve calcification were less in sevelamer-treated than in calcium-treated subjects, but not significantly so. When combining valvular and vascular calcification, the median (10%, 90%) change in sevelamer-treated subjects was significantly lower than in calcium-treated subjects (6, -5084 to 1180 versus 81, -1150 to 2944, p = 0.04). The effect of sevelamer remained significant after adjustment for baseline calcification and the time-averaged calcium-phosphorus product, and was independent of the calcium preparation (acetate versus carbonate), geographic region (US versus Europe), LDL- or HDL-cholesterol, C-reactive protein and statin use. Significantly more sevelamer-treated subjects experienced an arrest (45 versus 28%, p = 0.047) or regression (26 versus 10%, p = 0.02) in total valvular and vascular calcification. CONCLUSION: Sevelamer arrested the progression of valvular and vascular calcification in almost 50% of hemodialysis subjects. Sevelamer treatment, plus intensive control of calcium and phosphorus levels, may attenuate progression of, or achieve regression in, cardiac valvular calcification.

Acetates↗

In vitro calcification of pericardial bioprostheses.

BACKGROUND AND AIM OF THE STUDY: The lifetime of bioprosthetic heart valves is limited by calcification. To investigate the calcification behavior of bioprostheses and gain insight into the etiology of valve calcification, a test protocol for accelerated valve calcification was developed. This protocol includes a pulsatile valve tester, a synthetic calcification fluid, and non-destructive radiographic assessment of calcification sites. About 40 porcine bioprostheses from different manufacturers have been investigated previously using this test protocol and showed that valves exhibited different calcification patterns and even different degrees of calcification within their leaflets. A positive correlation of calcification versus tissue anomalies/stress concentrations (r = 0.72; n = 29 valves) and lipid deposits (r = 0.81) was found. In the present study, bovine pericardial valves were investigated in comparison with porcine valves. METHODS: Four bovine pericardial and two porcine mitral valves (Baxter) with a tissue annulus diameter (TAD) of 29 mm (one 27 mm) were investigated in parallel under identical test conditions. The valves were cyclically loaded at 300 per min with a delta p of 110 mmHg at 37 degrees C for up to 19 x 10(6) cycles. The synthetic calcification fluid was changed weekly. Sites of calcification were assessed by microradiography. Radiographs were analyzed by PC images processing with respect to the degree of calcification, defined as calcified surface area in relation to total leaflet surface area. RESULTS: This analysis showed that, for bovine pericardial valves, the mean degree of calcification increased by 14% and 20% after 12 and 19 x 10(6) cycles, respectively. Under identical conditions, the mean degree of calcification of porcine valves increased by 28% and 37%. CONCLUSIONS: Pericardial valves appear less prone to calcification than porcine valves. Further studies must be performed in order to prove this finding since, as recognized previously in porcine valves, other factors such as tissue or manufacturing anomalies may be as important as the tissue source itself.

Animals↗

Bisphosphonates alendronate and ibandronate inhibit artery calcification at doses comparable to those that inhibit bone resorption.

The present experiments were carried out to test the hypothesis that artery calcification is linked to bone resorption by determining whether the selective inhibition of bone resorption with the bisphosphonates alendronate and ibandronate will inhibit artery calcification. Artery calcification was first induced by treatment of 42-day-old male rats with warfarin, a procedure that inhibits the gamma-carboxylation of matrix Gla protein and has been shown to cause extensive calcification of the artery media within 2 weeks. These experiments revealed that ibandronate (0.05 mg. kg(-1). d(-1)) and alendronate (0.1 mg x kg(-1) x d(-1)) completely inhibited calcification of all arteries and heart valves examined after 2 and 4 weeks of warfarin treatment. A 10-fold lower dose of alendronate reduced artery calcification by 50% (P<0.005). These bisphosphonate doses are comparable to those that inhibit bone resorption in rats of this age. More rapid artery calcification was induced by treatment with warfarin together with high doses of vitamin D, a procedure that causes extensive artery calcification by 84 hours. Alendronate and ibandronate again completely inhibited calcification of all arteries and heart valves examined. The subcutaneous doses of alendronate and ibandronate necessary to inhibit artery calcification are comparable to the daily subcutaneous doses of these drugs that have previously been shown to inhibit bone resorption in rats of the same age, with 50% inhibition of artery calcification at 20 microg alendronate x kg(-1) x d(-1) and at 1 microg ibandronate x kg(-1) x d(-1) x Bisphosphonate treatment did not affect serum calcium and phosphate, and so the inhibition of artery calcification cannot be due to a simple lowering of the serum calcium phosphate ion product. We conclude that bisphosphonates inhibit the calcification of arteries and heart valves at doses comparable to the doses that inhibit bone resorption. These results support the hypothesis that artery calcification is linked to bone resorption. The mechanism of this linkage remains to be established, however, and an alternative explanation for the present results is also considered.

Alendronate↗

Abdominal calcification in cystic fibrosis with meconium ileus: radiologic-pathologic correlation.

BACKGROUND: There is confusion in the radiological literature as to the site of abdominal calcification in cystic fibrosis (CF) with meconium ileus (MI) in neonates. PURPOSE: To correlate the site of radiographic abdominal calcification with histologic and operative findings. MATERIALS AND METHODS: A review of clinical, radiographic, surgical and histologic data in 58 neonates with CF and MI. RESULTS: Abdominal calcification was identified in 15 (26 %) neonates: on an abdominal radiograph in 8 (13 %), at laparotomy in 3 and histologically in 10 (37 %) of the 27 resected specimens. The radiographic pattern of calcification varied from small specks in three cases to small, better-defined areas in two. In the other three patients, the calcification was more extensive and curvilinear. Histologically, calcification was found to be intramural in ten resected specimens, of which two also had intraluminal and one serosal calcification. The more extensive, curvilinear calcification identified radiographically correlated with histologically proven dystrophic intramural calcification. The less marked flecks or discrete areas of radiographic calcification may represent intramural, serosal or intraluminal calcification. CONCLUSION: Intramural calcification is common microscopically in CF with MI. Extensive radiographic calcification in these patients is more likely to represent intramural rather than serosal or intraluminal calcification.

Calcinosis↗

Aortic and lower limb artery calcification in type 2 (non-insulin-dependent) diabetic patients and non-diabetic control subjects. A five year follow-up study.

The purpose of the present study was to assess among a representative group of middle-aged newly diagnosed type 2 diabetics and control subjects the baseline prevalence and 5-year incidence of arterial calcifications of aorta and lower limb and their relationship to cardiovascular morbidity. The relationship of baseline risk factors to the development of arterial calcifications was also studied. At the time of diagnosis the age-adjusted prevalence of aortic and lower limb intimal calcifications was higher in diabetics than in control subjects (aortic calcifications: 29 vs. 17% for men, P = 0.05; 26 vs. 19% for women, P = 0.06; lower limb intimal calcifications: 24 vs. 12% for men, P = 0.02; 10 vs. 7% for women; P = NS), whereas no significant difference in baseline prevalence of lower limb medial calcifications was observed (15 vs. 21% for men, 9 vs. 10% for women). The 5-yr incidence of aortic calcifications in both sexes and of lower limb calcifications in men was similar in diabetic and control subjects, but the incidence of lower limb calcifications was higher in diabetic women than in control women (intimal: 33 vs. 11%, P = 0.009: medial: 29 vs. 14%, P = 0.05). The baseline prevalence of abdominal aortic (37 vs. 22%, P = NS for diabetics; 42 vs. 16%, P = 0.02 for control subjects), lower limb intimal (24 vs. 16% for diabetics, P = NS; 15 vs. 7% for control subjects, P = NS) and medial calcifications (23 vs. 7% for diabetics, P = 0.03) were higher in subjects who developed intermittent claudication during the follow-up than in those free of it at the 5-yr examination. Abnormalities in VLDL-metabolism and high systolic blood pressure were associated with the development of aortic calcification in diabetic subjects. In conclusion, already at the time of diagnosis atherosclerotic calcifications are more prevalent in type 2 diabetics than in nondiabetic subjects. During the follow-up diabetic women, but not men, had higher incidence of lower limb intimal and medial calcifications than non-diabetic subjects. Arterial calcifications tended to be associated with the development of intermittent claudication during the follow-up in diabetic and control subjects.

Aorta, Abdominal↗

Calcification of the thoracic aorta by spiral computed tomography among hypertensive patients: associations and risk of ischemic cerebrovascular events.

BACKGROUND: Calcium is often deposited in the aorta, but the associations and clinical implications of calcification of the aorta have not yet been elucidated. METHODS: In a prospective cohort of 455 hypertensive patients with at least 1 additional risk factor for atherosclerosis that underwent dual slice spiral computed tomography of the chest for assessment of arterial calcification (mean age 65.7+/-5.8, range 52-80 years, 48% female), we assessed for calcifications of the ascending and descending aorta and their association with the risk of subsequent ischemic cerebrovascular events during 3-year follow-up. RESULTS: Calcification of the ascending or descending aorta was present in 342 (75%) patients (60% calcification of the ascending aorta and 56% of the descending aorta). The main associations of calcification of the thoracic aorta were increasing age and the presence of coronary calcification, mitral annulus calcification, and aortic valve calcification. In a logistic regression model the main predictors of ischemic cerebrovascular events (n=27) during follow-up were the presence of severe calcification (thickness of > or = 5 mm) of the descending aorta (OR 4.9, 95%CI 1.8 to 13.5) and cigarette smoking (OR 2.8, 95%CI 1.1 to 6.7). CONCLUSIONS: Calcification of the thoracic aorta is highly prevalent among women and men with hypertension, is age-related, and correlates with calcification of the coronary arteries and heart valves. Only severe calcification of the descending aorta is associated with subsequent ischemic cerebrovascular events, suggesting that calcification of the thoracic aorta is a marker of the burden of vascular disease.

Aged↗

Automatic detection of calcifications in the aorta from CT scans of the abdomen. 3D computer-aided diagnosis.

RATIONALE AND OBJECTIVES: Automated detection and quantification of arterial calcifications can facilitate epidemiologic research and, eventually, the use of full-body calcium scoring in clinical practice. An automatic computerized method to detect calcifications in CT scans is presented. MATERIALS AND METHODS: Forty abdominal CT scans have been randomly selected from clinical practice. They all contained contrast material and belonged to one of four categories: containing "no," "small," "moderate," or "large" amounts of arterial calcification. There were ten scans in each category. The experiments were restricted to the vertical range from the point where the superior mesenteric artery branches off of the descending aorta until the first bifurcation of the iliac arteries. The automatic method starts by extracting all connected objects above 220 Hounsfield units (HU) from the scan. These objects include all calcifications, as well as bony structures and contrast material. To distinguish calcifications from non-calcifications, a number of features are calculated for each object. These features are based on the object's size, location, shape characteristics, and surrounding structures. Subsequently a classification of each object is performed in two stages. First the probability that an object represents a calcification is computed assuming a multivariate Gaussian distribution for the calcifications. Objects with low probability are discarded. The remaining objects are then classified into calcifications and non-calcifications using a 5-nearest-neighbor classifier and sequential forward feature selection. Based on the total volume of calcifications determined by the system, the scan is assigned to one of the four categories mentioned above. RESULTS: The 40 scans contained a total of 249 calcifications as determined by a human observer. The method detected 209 calcifications (sensitivity 83.9%) at the expense of on average 1.0 false-positive object per scan. The correct category label was assigned to 30 scans and only 2 scans were off by more than one category. Most incorrect classifications can be attributed to the presence of contrast material in the scans. CONCLUSION: It is possible to identify the majority of arterial calcifications in abdominal CT scans in a completely automatic fashion with few false positive objects, even if the scans contain contrast material.

Aorta, Abdominal↗