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At least 649 records · Page 36Linked to original sources
PubMed2000

Accuracy of three-dimensional gadolinium-enhanced MR angiography in the assessment of extracranial carotid artery disease.

OBJECTIVE: The purpose of this study was to assess three-dimensional (3D) gadolinium-enhanced MR angiography, used alone or in association with duplex Doppler sonography, with a fast acquisition time (8 sec) for evaluating the extracranial carotid arteries. SUBJECTS AND METHODS: In this prospective study, 48 successive patients with carotid artery stenoses were examined with 3D gadolinium-enhanced MR angiography and 3D time-of-flight MR angiography. Of the 44 eligible patients, conventional angiography was available in 33 and duplex sonography in 27. We used the North American Symptomatic Carotid Endarterectomy Trial technique to quantify stenosis on all angiograms, and a 250 cm/sec threshold at duplex sonography to diagnose stenoses greater than 70%. Image quality of 3D gadolinium-enhanced MR angiography and 3D time-of-flight MR angiography was assessed, as well as sensitivity and specificity for each technique alone and in combination with duplex sonography. Conventional angiography was the gold standard. RESULTS: Three-dimensional gadolinium-enhanced MR angiography yielded good image quality in 90% of cases. When used alone, it yielded a sensitivity and a specificity of 94% and 85%, respectively, in screening stenoses greater than 70% (70-99%). When combined with duplex Doppler sonography, it provided a 100% sensitivity and specificity for detection of stenoses between 70% and 99% and would have obviated 61% of conventional angiography. In comparison, 3D time-of-flight MR angiography used alone yielded a sensitivity of 88% and a specificity of 94%. In combination with duplex Doppler sonography, its use would have obviated conventional angiography in 74% of cases. Three-dimensional gadolinium-enhanced MR angiography provided accurate results in the diagnosis of occlusions and ulcers and can visualize distant stenoses. CONCLUSION: Used alone, 3D gadolinium-enhanced MR angiography is not accurate enough to replace conventional angiography in the evaluation of extracranial carotid arteries. In association with duplex Doppler sonography, however, it is accurate and may obviate a significant number of conventional angiographic examinations.

Adult↗
PubMed2002

Thin-section multidetector CT angiography of renal artery stents.

OBJECTIVE: This study was undertaken as a pilot investigation to compare multidetector CT angiography with conventional catheter angiography for the visualization of the renal artery lumen after renal artery stent placement. SUBJECTS AND METHODS: CT angiography was performed within 24-48 hr of renal artery stent placement in 15 patients. Two patients had bilateral stents, resulting in a total of 17 stents. CT angiography was performed using a multidetector scanner and a bolus of IV contrast material with the scanning delay determined by a small-volume timing bolus. A volumetric data set was acquired through the stented arteries in the axial plane using a 4.0 x 1.25 mm detector configuration and a pitch of 3:1. The stent lumen diameter, as measured on direct CT angiography and curved multiplanar reformations in both the axial and coronal planes, was compared with that measured on catheter angiography. RESULTS: The lumina of all 17 stents were well visualized and patent on both CT angiography and catheter angiography. Anatomic definition, including stent position and wall apposition in the renal artery, correlated well with catheter angiography. The diameter of the renal artery stent lumen measured on catheter angiography (mean, 5.9 +/- 1.3 mm) was greater than that on CT angiography (mean stent lumen diameter for direct axial plane was 4.6 +/- 1.0 mm, for curved multiplanar reformations in the axial plane was 4.3 +/- 1.0 mm, and for curved multiplanar reformations in the coronal plane was 4.4 +/- 1.0 mm) in 14 (82%) of 17 stents. CONCLUSION: CT angiography produced interpretable multiplanar images of the renal artery, even with a metallic stent in place, and was adequate for determining stent patency. Compared with catheter angiography, the intrastent luminal diameter was underestimated in most patients who underwent CT angiography.

Adult↗
PubMed2004

Comparison of routine and selective use of intraoperative angiography during aneurysm surgery: a prospective assessment.

OBJECT: Whether routine intraoperative angiography is necessary for cerebral aneurysm surgery is currently under debate. In this study the authors prospectively assessed the cerebrovascular surgeon's accuracy in predicting the need for intraoperative angiography. METHODS: Between January 2002 and January 2003, 200 consecutive patients (141 female and 59 male patients, mean age 52.8 years) with 235 aneurysms underwent routine intraoperative angiography. Before the operation, the surgeons indicated whether they believed that intraoperative angiography was necessary. Their responses were recorded as "intraoperative angiography necessary" or "intraoperative angiography unnecessary." Regardless of the response, all patients underwent intraoperative angiography after the aneurysm had been clipped. Changes in treatment resulting from intraoperative angiography were compared with surgeons' preoperative predictions of the need for intraoperative angiography. Intraoperative angiography was predicted to be necessary in 41 cases (20%) and unnecessary in 159 cases (80%). Its use altered treatment in 14 patients. Seven of these patients were among the group in which intraoperative angiography was deemed necessary and seven were in the group in which it was considered unnecessary. In the latter group, two patients had residual aneurysms, three had parent vessel occlusion, and two had previously undiagnosed aneurysms. Only one patient (0.5%) sustained a major intraoperative complication attributed to angiography. CONCLUSIONS: Given the frequency of significant disease that remains undetected if intraoperative angiography is used on a selective basis and the low complication rate associated with the procedure, the use of intraoperative angiography should be considered in the majority of aneurysm cases.

Adolescent↗
PubMed2002

Efficiency of CT-angiography in the diagnosis of intracranial aneurysms.

BACKGROUND: CT-angiography is a non-invasive method, alternative to cerebral angiography in the diagnosis of intracranial aneurysms. The aim of the study was the assessment of the efficiency of CT-angiography in a large material, which has been mostly verified with angiography and/or surgery. MATERIAL/METHODS: CT-angiography was performed in 196 patients with intracranial bleeding. Seventy-three (73) patients underwent also cerebral angiography (CA), 121 were operated on, 74 of them solely on the basis of CT-angiography. A spiral CT scanning (2 mm slices, 1-1.5 pitch, 1 mm-gap reconstruction) combined with an injection of 120 mL of contrast medium (5 mL/sec) was used. Subsequently three-dimensional MIP reconstructions were received, supplemented in some cases with SSD, VRT and MPR. RESULTS: CT-angiography revealed 128 aneurysms in 106 patients, located mostly in anterior communicating, middle cerebral and internal carotid arteries. The size of most aneurysms was 6-10 mm, but nearly one-third of them did not exceed 5 mm. In the group of patients who underwent CA, there was only 1 false negative CT-angiography result, while in 7 patients CT-angiography allowed for the diagnosis of small aneurysms which were not clearly visible on CA. CT-angiography was superior to CA in assessment of aneurysm morphology by 3 independent radiologists in 17 out of 22 cases. CT-angiography findings were confirmed during surgery in all 74 patients. CONCLUSIONS: CT-angiography is highly effective in the diagnosis of intracranial aneurysms and the evaluation of their morphology. In our opinion, in most cases, CT-angiography is precise enough to plan a surgical or endovascular procedure.

Cerebral Angiography↗
PubMedDate not supplied

Indocyanine green angiography in high myopia.

BACKGROUND AND OBJECTIVE: To evaluate indocyanine green imaging of choroidal changes in pathologic myopia and to compare it with fluorescein angiography. PATIENTS AND METHODS: The angiograms of all consecutive patients with pathologic myopia photographed with confocal indocyanine green angiography using a scanning infrared laser or ophthalmoscope from March 1997 to December 1999 were reviewed. RESULTS: Twenty-one patients (35 eyes) were included. Indocyanine green angiography was performed in 35 eyes and immediate sequential fluorescein angiography and indocyanine green angiography in 25 eyes. The lacquer cracks were demonstrated to radiate from the disc, at the papillomacular bundle, through the macula, and around the macula. Lacquer cracks were identified in 89% and 28% of the eyes, respectively. Choroidal neovascularization (CNV) was demonstrated in 57% of eyes by indocyanine green angiography and in 56% by fluorescein angiography. All of the CNVs were classic and were located within 300 microm of the foveal center. Seventy percent of the CNVs were delineated in lacquer cracks by indocyanine green angiography. Overall, 124 lacquer cracks were identified by indocyanine green angiography and only 14 by fluorescein angiography. Lipids or serous detachment were not observed. Retinal hemorrhages were noted in 22% and 28% of eyes with indocyanine green angiography and fluorescein angiography, respectively. CONCLUSION: Confocal indocyanine green angiography offers better delineation of lacquer cracks and the localization of the CNV in lacquer cracks than does fluorescein angiography.

Choroidal Neovascularization↗
PubMed1997

MR and conventional angiography: work in progress toward assessing utility in radiology.

RATIONALE AND OBJECTIVES: The authors assessed health-related quality of life changes associated with peripheral x-ray angiography and magnetic resonance (MR) angiography. MATERIALS AND METHODS: Utility (the desirability or preference that individuals exhibit for a particular health state) was assessed in 30 patients with peripheral vascular disease referred for angiography by using a rating scale, additional categoric scaling questions to separate preference from experience, a willingness-to-pay technique, functional and cognitive status questions, and a time trade-off technique. All patients underwent both MR angiography and x-ray angiography. RESULTS: Patients reported significantly (P < .05) less anxiety after the test, less pain after the test, fewer new physical limitations, and less effect on performance of daily activities with MR angiography. Findings from the overall rating scale and categoric scaling questions also significantly (P < .05) favored MR angiography. Patients were willing to pay a mean of 2.12% of annual income to avoid MR angiography and a mean of 7.41% to avoid x-ray angiography. The median quality-adjusted life gain required by patients to undergo the procedures was 52.5-60 days for x-ray angiography and 10.5 days for MR angiography, without discounting. CONCLUSION: X-ray angiography has more profound short-term adverse effects on life than does MR angiography. Preference-based measures can be adapted to elicit patient values for short-term health states as seen in radiology.

Angiography↗
PubMed2006

Peripheral arteries in diabetic patients: standard bolus-chase and time-resolved MR angiography.

PURPOSE: To prospectively determine the diagnostic performance of a combination of standard bolus-chase magnetic resonance (MR) angiography and MR angiography with time-resolved imaging of contrast kinetics (TRICKS) for depicting severity of peripheral vascular disease of the lower extremity, including the pedal arteries, in diabetic patients with digital subtraction angiography (DSA) as the reference standard. MATERIALS AND METHODS: An ethical committee approved this study; written informed consent was obtained from patients. Standard three-station and TRICKS MR angiography of the calf and foot were performed in 31 consecutive diabetic patients (23 men, eight women; mean age, 67 years; range, 43-81 years). Two readers separately assessed images of arterial segments as diagnostic or nondiagnostic and graded stenosis. Results were compared with those at DSA when the corresponding arterial segments were considered diagnostic at DSA. Wilcoxon signed rank test was used to determine if a significant difference between imaging techniques existed, and kappa statistics were used to determine interobserver agreement. RESULTS: The difference between standard MR angiography and DSA regarding the number of diagnostic segments in the thigh was not significant (P = .50). A significantly higher number of calf and foot segments was considered diagnostic at TRICKS MR angiography than at standard MR angiography (P < .025). Sixteen of 26 segments in the foot that were considered nondiagnostic at DSA were considered diagnostic at TRICKS MR angiography. Average sensitivity of standard MR angiography for depicting hemodynamically significant arterial stenosis was 84% (reader 1) and 83% (reader 2) in the thigh and 78% (reader 1) and 80% (reader 2) in the calf. For both readers, average specificity was 97% in the thigh and 90% in the calf. Sensitivity and specificity of TRICKS MR angiography in the calf and foot were improved compared with those at standard MR angiography. CONCLUSION: TRICKS MR angiography of the distal calf and pedal vessels is superior to standard MR angiography regarding the number of diagnostic segments and assessment of the degree of luminal narrowing.

Adult↗
PubMed2003

Accuracy of contrast-enhanced MR angiography in predicting angiographic stenosis of the internal carotid artery: linear regression analysis.

BACKGROUND AND PURPOSE: We sought to assess whether contrast-enhanced MR angiography is able to predict the degree of angiographic stenosis of the internal carotid artery within a clinically acceptable margin of error, thereby decreasing the need for angiography. In addition, we sought to assess whether adding ultrasound peak systolic velocity (PSV) as an additional regressor improves the accuracy of prediction. METHODS: A retrospective review of our institution's records for a 4-year period was conducted to identify all patients who had undergone evaluation of their carotid arteries using digital subtraction angiography, contrast-enhanced MR angiography, and ultrasonography. All internal carotid artery stenoses ranging from 10% to 90% at carotid angiography were selected (n = 22). Measurements were then obtained based on the North American Symptomatic Carotid Endarterectomy Trial style by using the digital subtraction angiograms and contrast-enhanced MR angiograms in a blinded fashion. The correlation between digital subtraction angiography data and contrast-enhanced MR angiography data was assessed by conducting linear regression analysis. Multiple regression analysis was then conducted to determine whether the inclusion of ultrasound PSV as an additional regressor increased the accuracy of prediction. RESULTS: The correlation between the degree of stenosis measured by digital subtraction angiography and that measured by contrast-enhanced MR angiography was r = 0.967. The 95% confidence interval for the line of means showed low errors bounds, ranging as low as +/-2.8%. The 95% confidence interval for individual prediction of angiographic stenosis based on a given contrast-enhanced MR angiographic measurement, however, was significantly larger, being no less than +/-13.6%. With the inclusion of PSV, the adjusted correlation was r = 0.965. CONCLUSION: A clear linear relationship exists between digital subtraction angiographic and contrast-enhanced MR angiographic measurements of carotid stenosis. Increasing severity of stenosis as measured by contrast-enhanced MR angiography corresponds to increasing severity at angiography. Although the predictive value of contrast-enhanced MR angiography is excellent in the mean, it is less reliable for predicting the degree of angiographic stenosis in the individual patient, showing rather wide confidence intervals. Furthermore, the inclusion of PSV as an additional regressor does not improve the predictive accuracy beyond that of contrast-enhanced MR angiography alone.

Angiography, Digital Subtraction↗
PubMed2001

Safety of indocyanine green angiography during pregnancy: a survey of the retina, macula, and vitreous societies.

OBJECTIVES: To establish current practice patterns and assess the general knowledge among vitreoretinal-trained physicians regarding the use of indocyanine green (ICG) angiography during pregnancy, and to review the literature regarding the established safety of ICG angiography in pregnant women. METHODS: A survey was mailed to 1101 members of the Retina, Macula, and Vitreous Societies. RESULTS: Of the 520 respondents, 434 (83%) had seen at least 1 pregnant woman who required ICG angiography or fluorescein angiography. Of these, 385 (89%) withheld fluorescein angiography and 105 (24%) withheld ICG angiography, largely because of fear of teratogenicity or lawsuit. Diabetic retinopathy and choroidal neovascular membrane were the most common indications for fluorescein angiography, and choroidal neovascular membrane and choroidal tumor were the most common indications for ICG angiography. Only 24% thought that it was safe to use ICG angiography in a pregnant patient, and only 5% thought it was safer than fluorescein angiography. CONCLUSIONS: Despite the documented safety of ICG when used for retinal angiography and the extensive experience with the use of intravenous ICG to measure hepatic blood flow in pregnant women, the results of this survey suggest widespread hesitation to use ICG for retinal angiography in pregnant women. Current practice patterns regarding the use of ICG angiography in pregnant patients may be unnecessarily restrictive.

Choroidal Neovascularization↗
PubMed2002

Value of MR angiography before percutaneous transluminal renal artery angioplasty and stent placement.

PURPOSE: To determine the benefit of preprocedural three-dimensional gadolinium (Gd)-enhanced magnetic resonance (MR) angiography before percutaneous transluminal renal artery angioplasty and stent placement (PTRA/S) in terms of procedural success, iodinated contrast material load, and procedure duration. MATERIALS AND METHODS: Over an 18-month period, 39 patients underwent attempted percutaneous renal angioplasty with or without stent placement. A total of 48 renal arteries were treated (40 cases of atherosclerosis, one of stent restenosis, five of fibromuscular dysplasia, and two of transplant stenosis). Preprocedural Gd-enhanced MR angiography was available in 16 procedures (41%). Procedural outcome, complications, iodinated contrast material load, number of diagnostic angiographic runs, and total procedure duration were each compared between two subgroups: patients who had preprocedural Gd-enhanced MR angiography ("prior MR angiography group") and those who did not ("no MR angiography" group). RESULTS: All procedures were technically successful. The two groups were equivalent in terms of age and disease pattern. However, technical complexity of the procedure was judged to be high in five of 16 procedures in the prior MR angiography group compared to three of 23 procedures in the no MR angiography group (P =.16). Bilateral or dual interventions were performed in six of 16 procedures in the prior MR angiography group compared to three of 23 in the no MR angiography group (P =.075). Iodinated contrast material load was significantly lower in the prior MR angiography group than in the no MR angiography group (68.7 mL +/- 28.4 vs 119.1 mL +/- 49.2 mL;P <.0008). The number of diagnostic angiographic runs before interventions were also significantly lower in the prior MR angiography group (1.2 +/- 0.4 vs 2.6 +/- 0.7; P <.0001). Overall procedure duration was comparable between the two groups (91.9 +/- 47.8 vs 112.2 +/- 49.4;P =.2). CONCLUSION: Preprocedural planning with use of Gd-enhanced MR angiography significantly reduces the iodinated contrast material requirement during percutaneous renal artery interventions. It can also significantly shorten procedure duration.

Aged↗
PubMed2000

Comparison of Doppler ultrasound, magnetic resonance angiographic techniques and catheter angiography in evaluation of carotid stenosis.

AIM: To compare the accuracy of ultrasound and two magnetic resonance (MR) angiographic techniques with catheter angiography in assessing atherosclerosis at the carotid bifurcation. MATERIALS AND METHODS: Forty patients with symptomatic carotid stenosis were studied by Doppler ultrasound, time-of-flight MR angiography, contrast-enhanced MR angiography and conventional catheter angiography. The degree of stenosis found on ultrasound and MR angiography was compared with the results of catheter angiography. Four different assessment methods were conducted for the MR angiographic data. Kappa, sensitivity and specificity (with confidence intervals) values were calculated for the US and MR angiography results compared to catheter angiography. RESULTS: Catheter angiography showed 12 internal carotid artery occlusions (15%), 34 severe (44%), 12 moderate (15%) and 20 mild stenoses (26%), using NASCET criteria. Ultrasound showed 65% sensitivity and 95% specificity in detecting surgically amenable lesions, whilst the MR angiographic techniques had sensitivities varying from 82-100%, and specificities from 95-100%.A moderate kappa value was calculated for the US data, whilst all MR techniques were found to show very good agreement with catheter angiography. CONCLUSION: This data suggests that MR angiography is more accurate than Doppler ultrasound in defining surgical lesions and has comparable accuracy to catheter angiography. The use of contrast-enhanced MR angiography is useful in certain situations but is not essential in all cases.

Aged↗
PubMed1999

Intraoperative angiography of brain arteriovenous malformations.

OBJECTIVE: The gold standard for documentation of surgical cure of a brain arteriovenous malformation (AVM) is a postoperative angiogram. Intraoperative angiography also has been used for assessing surgical obliteration of AVMs. The objective of this work is to determine the incidence of unexpected residual AVM in patients undergoing intraoperative angiography after brain AVM surgery, the incidence of false-negative intraoperative angiography, and whether there are any identifiable factors that would predict such an occurrence. METHODS: Patient age and sex, AVM location and size, clinical presentation of the AVM, day of surgery after hemorrhage, whether embolization was performed preoperatively, presence of intraoperative brain swelling or substantial bleeding, and postoperative course were recorded prospectively on 34 consecutive patients who underwent surgery for brain AVMs. Intraoperative angiography was performed after the surgeon thought that the AVM was completely obliterated. The incidence of unexpected residual AVM and false-negative intraoperative angiography was determined. Factors predicting these findings were identified by multivariate analysis. RESULTS: Twenty-five of 34 patients underwent intraoperative angiography to assess the extent of resection, and two patients underwent the examination to localize the AVM. Postoperative angiograms were obtained for 26 patients. Intraoperative angiography showed unexpected residual AVM in 2 (8%) of 25 patients. In two patients, intraoperative angiography was useful to locate a small AVM in the wall of a hematoma cavity. Three patients (18%) whose intraoperative angiograms had not shown AVM had postoperative angiograms that showed residual or recurrent AVM. One (11%) of nine patients who had only postoperative angiography had an unexpected residual nidus; the patient underwent a reoperation and successful resection. There were no significant clinical or radiological features that predicted the intraoperative angiographic finding of residual AVM or of false-negative intraoperative angiogram. CONCLUSION: Intraoperative angiography is useful to demonstrate residual AVM in about 8% of patients undergoing AVM resection. It can be used to localize small AVMs, but other methods for localization may be as useful and may avoid the risks and cost of additional angiography. Intraoperative angiography does not replace postoperative angiography to confirm AVM removal because of false-negative findings, which occurred in 18% of patients in this series.

Adult↗
PubMed2005

Coronary artery stenoses: detection with calcium scoring, CT angiography, and both methods combined.

PURPOSE: To investigate prospectively the relative accuracy of computed tomographic (CT) angiography, calcium scoring (CS), and both methods combined in demonstrating coronary artery stenoses by using conventional angiography as the reference standard. MATERIALS AND METHODS: The study was approved by the institutional review board Human Research Ethics Committee, and all patients completed written informed consent. Fifty patients (40 men, 10 women) aged 62 years +/- 11 (+/- standard deviation) who were suspected of having coronary artery disease underwent both conventional coronary angiography and multisection coronary CT angiography with CS. Sensitivity and specificity of CS, CT angiography, and both methods combined in demonstrating luminal stenosis greater than or equal to 50% were determined for each arterial segment, coronary vessel, and patient. Receiver operating characteristic (ROC) curves were generated for CS prediction of significant stenosis, and the Mann-Whitney U test was used for comparison of CS between groups. RESULTS: When used with segment-specific electrocardiographic phase reconstructions, CT angiography demonstrated stenosed segments with 79% sensitivity and 95% specificity. Mean calcium score was greater in segments, vessels, and patients with stenoses than in segments, vessels, and patients without stenoses (P < .001 for all); nine (16%) of 56 stenosed segments, however, had a calcium score of 0. The patient calcium score correlated strongly with the number of stenosed arteries (Spearman rho = 0.75, P < .001). CS was more accurate in demonstrating stenosis in patients than in segments (areas under ROC curve were 0.88 and 0.74, respectively). CT angiography, however, was more accurate than CS in demonstrating stenosis in patients, vessels, and segments. The sensitivity and specificity of CS varied according to the threshold used, but when the calcium score cutoff (ie, >150) matched the specificity of CT angiography (95%), the sensitivity of CS in demonstrating stenosed segments was 29% (compared with 79% for CT angiography). Combining CT angiography with CS (at threshold of 400) improved the sensitivity of CT angiography (from 93% to 100%) in demonstrating significant coronary disease in patients, without a loss of specificity (85%); this finding, however, was not statistically significant. CONCLUSION: CT angiography is more accurate than CS in demonstrating coronary stenoses. A patient calcium score of greater than or equal to 400, however, can be used to potentially identify patients with significant coronary stenoses not detected at CT angiography.

Adult↗
PubMed1998

Takayasu arteritis: evaluation of the thoracic aorta with CT angiography.

PURPOSE: To determine the diagnostic accuracy of computed tomographic (CT) angiography in the evaluation of Takayasu arteritis. MATERIALS AND METHODS: Twenty-five patients with clinical symptoms suggestive of Takayasu arteritis underwent CT angiography and conventional angiography. Takayasu arteritis was diagnosed in 20 patients on the basis of conventional angiography. CT angiography was performed with a helical CT scanner after injection of a bolus of contrast material, and images were generated for three-dimensional display, multiplanar reformation, and maximum intensity projection. For vascular assessment, all images from CT angiography were used, and the results were compared with those from conventional angiography. RESULTS: CT angiography clearly depicted various luminal changes, including stenosis, occlusion, dilatation, and aneurysm, in the thoracic aorta and its major branches. CT angiography accurately depicted 190 (95%) of 200 arteries, although the extent of the steno-occlusive lesions was overestimated in five (2%) and underestimated in five (2%). Furthermore, CT angiography depicted mural changes, including wall thickening, calcification, and mural thrombi, not seen with conventional angiography. The sensitivity and specificity of CT angiography in the diagnosis of Takayasu arteritis were 95% and 100%, respectively. CONCLUSION: CT angiography clearly depicts both luminal and mural changes in the thoracic aorta and its major branches and has a high accuracy in the diagnosis of Takayasu arteritis.

Adolescent↗
PubMed1989

Intracoronary thrombus and complex morphology in unstable angina. Relation to timing of angiography and in-hospital cardiac events.

In 78 consecutive patients with unstable angina, we performed coronary angiography randomized to either the first day of presentation or later during the hospital admission to assess the frequency of intracoronary thrombus and complex coronary morphology relative to the time of symptomatic presentation and the impact of these angiographic features on outcome. Early angiography (17 +/- 6 hours) was performed in 42 patients and late angiography in 36 patients (5.7 +/- 2.1 days). Twelve patients randomized to late angiography required urgent cardiac catheterization 3.9 +/- 2.2 days after admission. Coronary thrombi were present in 43% (18 of 42) of early angiography patients and in 38% (14 of 36) of late angiography patients (p = NS). Only 21% (five of 24) late elective angiography patients had coronary thrombi, but 75% (nine of 12) of late urgent angiography patients had thrombi (p less than 0.05 vs. both early and late elective angiography patients). There was no difference in the frequency of complex coronary morphology among patients randomized to early angiography (42%, or 15 of 36), late urgent angiography (42%, or five of 12), and late elective angiography (38%, or nine of 24). Cardiac events (death, myocardial infarction, and urgent revascularization) were more frequent in the patients with coronary thrombus (73%, or 23 of 32), complex coronary morphology (55%, or 16 of 29), and multiple-vessel disease (58%, or 29 of 50) than in the patients without these angiographic features (17%, or eight of 46; 31%, or 15 of 49; and 7%, or two of 28, respectively; all p less than 0.05). Multiple regression analysis demonstrated that coronary thrombus was the best angiographic predictor of cardiac events. Thus, angiographic detection of intracoronary thrombi varies according to the temporal relation between angiography and chest pain at rest.

Angina Pectoris↗
PubMed2005

Multi-detector row computed tomography angiography in diagnosing spinal dural arteriovenous fistula: initial experience.

BACKGROUND AND PURPOSE: Multi-detector computed tomographic (MDCT) angiography is a recently developed imaging technique that can study small vessels such as medullary arteries and veins. The purpose of this study was to evaluate MDCT angiography in diagnosing SDAVF. METHODS: Eight patients with initial magnetic resonance imaging (MRI) and clinical findings suggestive of spinal dural arteriovenous fistula (SDAVF) and 8 control subjects underwent MDCT angiography. Both MDCT angiography and catheter angiography were performed within 5 days in patients with SDAVFs. The results of MDCT angiography in patients with SDAVFs were compared with those of catheter angiography. RESULTS: MDCT angiography detected engorged perimedullary draining veins and correctly localized the fistula of the SDAVFs, and correlated well with catheter angiography. Fistula was at the thoracic level in 7 patients, and sacral level in 1 patient. MDCT angiography did not visualize the engorged perimedullary venous plexus in the control group. CONCLUSIONS: MDCT angiography correlated well with catheter angiography in diagnosing SDAVFs. It might play a role in shortening the length of the catheter angiography in diagnosing this disease.

Angiography↗
PubMed1987

Detection of prosthetic vascular complications: comparison of CT and angiography.

The value of CT and angiography to detect complications of prosthetic arterial grafting was compared in 24 patients. There was a total of 27 grafts including 18 aortic or aortofemoral, five femoral-popliteal, two femoral-femoral, and two axillary-femoral reconstructions. Nineteen grafts were uninfected; eight were infected. In the absence of infection, the complications and the percentages detected by the two procedures were as follows: five graft occlusions (CT 80%, angiography 100%), six pseudoaneurysms (CT 100%, angiography 83%), three with perigraft fluid (CT 100%, angiography 0%), and one with pseudointimal hyperplasia (CT 100%, angiography 0%). Seven grafts were normal and without abnormalities on both CT and angiography. In the presence of infection the results were as follows: eight with perigraft fluid (CT 100%, angiography 0%), four with perigraft or intragraft gas (CT 100%, angiography 0%), three pseudoaneurysms (CT 100%, angiography 100%), two open groin wounds (CT 100%, angiography 0%), and two graft occlusions (CT 100%, angiography 100%). In addition, three patients with infected grafts had graft enteric fistulae. All three had fluid around the proximal anastomosis and two had gas around the graft as well. The data show that angiography is sufficient for patients with graft occlusion if there is no suspicion of infection, postoperative hemorrhage, or anastomotic pseudoaneurysm. In these cases CT has an ancillary role in detecting hemorrhage and defining pseudoaneurysms. CT is superior to angiography in patients with graft infection.

Aneurysm↗
PubMed1996

Sequential helical CT angiography of aortoiliac disease.

OBJECTIVE: The purpose of this work was to study aortoiliac disease with sequential helical CT angiography. SUBJECTS AND METHODS: Sequential helical CT angiography combines two successive helical sets for data acquisition obtained during two successive bolus injections of IV contrast material and two breath-holds. Twenty-eight patients with aneurysm and 11 with occlusive disease had CT angiography. Of those 39 patients, 18 also had conventional catheter angiography. For each of the 39 patients, a CT angiogram of three segments of the aorta and 13 arteries was assessed, including the suprarenal, juxtarenal, and infrarenal aorta; celiac axis; superior and inferior mesenteric arteries; and pairs of renal, common iliac, hypogastric, external iliac, and common femoral arteries. In 18 patients undergoing both CT and conventional angiography, the appearance of these vessels was graded as occlusive (grade 0), severely stenotic (grade 1), moderately stenotic (grade 2), mildly stenotic (grade 3), normal (grade 4), ectatic (grade 5), and aneurysmal (grade 6). RESULTS: Of the 624 arteries expected to be opacified in 39 patients, 585 (94%) were actually imaged with CT angiography. In the 18 patients who had both CT angiography and catheter angiography, the two studies were in complete agreement in 243 (90%) of 269 arteries. In 13 vessels (5%), CT angiography produced an image that was one grade higher-and in 11 vessels (4%), one grade lower-than conventional angiography. In two vessels, a two-grade difference was noted. The independent readings matched on the 0-6 scale in 95% of the evaluations. An additional 5% of the readings differed by one unit. Compared with conventional angiography, CT angiography of clinically significant (> or = 85%) narrowing (grades 0 and 1) and aneurysm (grade 6) yielded sensitivity of 93%, specificity of 96%, and accuracy of 95%. CONCLUSION: Sequential helical CT angiography of the abdomen can provide sufficient vascular detail to allow evaluation of expanded vascular territories. The technique can allow accurate assessment of both stenotic and aneurysmal disease of the aorta and the iliac arteries.

Adult↗