Persistent left superior vena cava into left atrium.
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Adult↗
Biomedical subjects
Eijun Sueyoshi
Publications and source records attributed to Eijun Sueyoshi.
Diagnosis of perfusion abnormality of the pulmonary artery in Takayasu's arteritis using contrast-enhanced MR perfusion imaging.
To determine the clinical efficacy of contrast-enhanced magnetic resonance (MR) perfusion imaging in the diagnosis of perfusion abnormality in the pulmonary artery (PA) in Takayasu's arteritis (TA). Twenty-one patients were evaluated. Pulmonary MR perfusion images were acquired using a 2-dimensional (2D) fast spoiled gradient echo sequence with single-slice technique (TR/TE, 5.3/1.3; flip angle, 30 degrees; receiver bandwidth, 31.2 kHz/pixel; acquisition time, 0.7 s; and total acquisition time, 49 s). Seventy continuous subtracted MR images were evaluated, and the presence of perfusion abnormality was determined in lobe-based (n=126) and patient-based (n=21) analyses. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) were calculated using perfusion scintigraphy as a standard reference. For lobe-based analysis, sensitivity was 91.7-95.8%, specificity was 92.2-93.7%, and PPV and NPV were 73.3-76.7% and 97.9-99.0%, respectively. For patient-based analyses, sensitivity was 100%, specificity was 72.7%, and PPV and NPV were 76.9% and 100%, respectively. Kappa values for each analysis were between 0.78-1.00. In conclusion, MR perfusion imaging appears to be a valuable, noninvasive method to estimate PA involvement in patients with TA.
Adult↗
CT analysis of the growth rate of aortic diameter affected by acute type B intramural hematoma.
OBJECTIVE: The purpose of this study was to evaluate the growth rate of aortic diameter affected by acute type B intramural hematoma and the factors that influence its enlargement. MATERIALS AND METHODS: Fifty-four patients were entered into this study, and regular follow-up CT studies (mean +/- SD, 46.9 +/- 27.2 months; range, 5-136 months) were performed. The affected aortas and iliac arteries were divided into five segments. A total of 127 segments were evaluated (aortic arch, n = 47; descending thoracic aorta, n = 51; suprarenal abdominal aorta, n = 24; infrarenal abdominal aorta, n = 3; and iliac artery, n = 2). The growth rate of each segment was obtained on CT. The factors influencing increase in the diameter and growth rate--age, sex, diabetes mellitus, atherosclerotic disease, history of smoking 20 years, chronic renal failure, blood pressure, initial diameter of the lumen, the presence of blood flow in the false lumen--were evaluated by univariate analysis and a multivariate logistic regression model. RESULTS: Twenty (37.0%) of 54 patients had one or more segments that increased in size during the follow-up period. Of a total of 127 segments, 35 (27.6%) increased in size, and for all, the mean growth rate was -0.5 +/- 2.9 mm/year. This negative growth rate represents shrinkage. The mean growth rates within the first year and after 1 year from onset were -2.2 +/- 5.7 and 0.4 +/- 3.2 mm/year, respectively, and a significant difference was observed between them (p < 0.0001). An initial diameter of 40 mm or greater and the presence of blood flow in the false lumen were significant risk factors for an increase in the diameter, as confirmed by univariate and multivariate analyses. CONCLUSION: In patients with type B intramural hematoma, the affected aortas did not show a high incidence of enlargement during the follow-up period, but the affected aortas tended to increase in size after 1 year from onset. An initial diameter of 40 mm or greater and the presence of blood flow in the false lumen were important risk factors for enlargement during the follow-up period.
Adult↗
MRI of Takayasu's arteritis: typical appearances and complications.
OBJECTIVE: Although Takayasu's arteritis (TA) is more common in Asian countries, it has a worldwide distribution. MRI is widely used for its diagnosis. Our purpose is to present a comprehensive pictorial review of its typical appearances and complications on MRI. CONCLUSION: MRI can effectively provide almost all anatomic information in patients with TA. MRI is very useful for accurate diagnosis of TA and its complications. Knowledge of MRI findings is essential for improving patient outcome.
Adult↗
Endovascular treatment of iliac artery aneurysms.
Endovascular treatment is now an alternative to surgery for the treatment of iliac artery aneurysms (IAAs). A variety of minimally invasive therapeutic options are available (eg, coil embolization, stent-graft placement), and choosing an appropriate option is essential for achieving excellent long-term results and reducing potential complications. Preprocedural imaging with multi-detector row computed tomography or magnetic resonance imaging is necessary for evaluating patient eligibility and planning the interventional procedure. An imaging classification system for IAAs that is based on anatomic features and endovascular treatment options has been developed and may help determine therapeutic strategies for affected patients. Early experience indicates that endovascular treatment is safe and effective in treating IAAs, and it is expected that various devices that will make endovascular treatment easier to perform will soon become commercially available. However, large, long-term follow-up studies will be needed to determine whether this approach is a practical alternative to open surgery.
Aged↗
Visceral and peripheral arterial pseudoaneurysms.
OBJECTIVE: Pseudoaneurysms are not rare, and various conditions can cause a pseudoaneurysm in all the cardiovascular systems. In this article, we discuss and show images of pseudoaneurysms of various arteries caused by various conditions. CONCLUSION: CT, MRI, sonography, and angiography may all be valuable in the imaging workup of pseudoaneurysms. Knowledge of the various appearances of pseudoaneurysms and of the proper management is essential to prevent a catastrophic outcome in cases of pseudoaneurysm.
Aneurysm, False↗
Growth rate of aortic diameter in patients with type B aortic dissection during the chronic phase.
BACKGROUND: The purpose of this study was to evaluate the growth rate of type B double-barrel aortic dissection with computed tomography (CT) and the factors influencing its enlargement. METHODS AND RESULTS: Sixty-two patients were entered into this study, and regular follow-up CT studies (mean; 49.1 months) were performed. The affected aortas and iliac arteries were divided into 5 segments (aortic arch, descending thoracic, suprarenal abdominal, infrarenal abdominal aorta, and iliac artery). Fifty-two of 62 patients (83.9%) had 1 or more segments increased in size during follow-up period. In a total of 177 segments, the presence or absence of blood flow in the false lumen and aortic diameter were evaluated on CT during the follow-up period. The factors (gender, diabetes mellitus, atherosclerotic disease, smoking, entry site in arch, initial diameter, chronic obstructive pulmonary disease, blood pressure, and age) influencing increase in the diameter and growth rate were also evaluated. Of 177 segments, 132 segments (74.6%) increased in size during the follow-up period. The presence of blood flow in the false lumen was the only significant risk factor for increase in the diameter in the univariate and multivariate analysis. The group with blood flow in the false lumen had a significantly higher mean growth rate (3.3 mm/year) than the group without blood flow (-1.4 mm/year) (P<0.0001). The growth rate of aortic dissections in thoracic aorta and abdominal aorta were 4.1 and 1.2 mm/year, respectively. There was a significant difference in the growth rate between the 2 groups (P=0.0003). CONCLUSIONS: In type B aortic dissection, the affected aortas have shown a high incidence of enlargement during the follow-up period, and more careful follow-up study is needed for aortic dissections in the thoracic aorta. The presence of blood flow in the false lumen is the most important risk factor for aortic enlargement.
Adult↗
Long-term outcome of type B aortic intramural hematoma: comparison with classic aortic dissection treated by the same therapeutic strategy.
BACKGROUND: The long-term clinical course and therapeutic strategy of patients with type B aortic intramural hematoma (IMH) are not completely known. The purpose of this study was to clarify long-term prognosis of patients with type B IMH by comparison with type B classic aortic dissection (AD). METHODS: Clinical data were compared retrospectively between 37 patients with acute type B IMH (IMH group) and 69 patients with acute type B AD (AD group). Our therapeutic strategy for all patients was medical therapy with frequent follow-up imaging studies and timed surgical repair in cases with progression. RESULTS: Initially, medical therapy was selected for 104 of 106 (98%) patients. In two patients of the AD group, immediate surgical treatment was performed because of aortic rupture. As for complications, no significant difference was seen between the two groups. There was no significant difference in the incidence of the total number of deaths; early death, late death, or causes of deaths. The actuarial survival rates for the IMH group at 1, 2, 5, and 10 years were 97 +/- 3, 97 +/- 3, 85 +/- 9, and 85 +/- 9%, respectively; the values were 96 +/- 1, 96 +/- 1, 89 +/- 4, and 71 +/- 9%, for the AD group. The actuarial survival rates of the two groups were not significantly different from each other (p = 0.398). CONCLUSIONS: Patients with type B IMH have similar long-term prognosis to patients with type B AD. Medical therapy with frequent follow-up imaging studies and timed surgical repair in cases with progression can be a rational therapeutic strategy in patients with type B IMH.
Aged↗
Pulmonary and lower extremity vascular lesions in a patient with homocystinuria: radiologic findings.
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Adult↗
Coil embolization of iliac artery aneurysms developing after abdominal aortic aneurysm repair with a conventional bifurcated graft.
PURPOSE: To evaluate the efficacy of embolizing iliac artery aneurysms (IAAs) developing after abdominal aortic aneurysm (AAA) repair. METHODS: The records of 6 patients (5 men; mean age 79 years, range 61-87) with unilateral (n=3) or bilateral (n=3) IAAs that had developed after AAA repair were reviewed. In all patients, the limbs of the bifurcated graft were anastomosed end-to-end or end-to-side with the external iliac arteries during AAA repair. Before embolization, superior mesenteric artery (SMA) arteriography was done in all patients to evaluate collateral pathways to the inferior mesenteric artery (IMA). RESULTS: The unilateral IAAs were treated by proximal and distal embolization. In 2 patients with bilateral IAAs, SMA angiography showed sufficient collateral flow to the IMA, so the aneurysms were treated by proximal embolization and packing. In the other bilateral IAA case, the left 6-cm IAA was treated by proximal and distal embolization, while the contralateral 3-cm IAA was not embolized because angiography demonstrated inadequate collateral flow to the IMA, indicating a possible risk of colon ischemia if both IAAs were embolized. Immediate postprocedural angiography in all patients showed complete exclusion of the IAAs. Mild buttock claudication occurred in 1 patient. There were no episodes of rupture over a mean 46-month follow-up. CONCLUSIONS: Embolization is a safe and effective alternative to open surgery for the treatment of IAAs that develop after AAA repair. However, before embolization, angiographic evaluation of collateral pathways to the IMA is essential to reduce the risk of colon ischemia.
Aged↗
Analysis of predictive factors for progression of type B aortic intramural hematoma with computed tomography.
PURPOSE: For patients with Stanford type B aortic intramural hematoma (IMH), medical treatment is usually selected. However, the outcomes of patients with type B IMH are not completely understood, and some cases can have fatal complications develop or surgical treatment necessitated. The purpose of this study was to investigate predictors of progression of the affected aorta in patients with type B IMH with initial computed tomography (CT) images. METHODS: Thirty-five patients with type B IMH were studied with serial CT images. Initially, medical therapy was selected for all patients. CT findings of the affected aorta were evaluated on admission and at follow-up. We divided the patients into two groups (progression group or regression group) on the basis of CT findings and investigated predictors of progression of the affected aorta with initial CT images. RESULTS: We defined 15 patients who showed increased maximum aortic diameter (n = 14), increased maximum aortic wall thickness (n = 3), progression to overt dissection (n = 4), or rupture of the aortic wall (n = 2) during the follow-up period as the progression group. The other 20 patients, who all showed decreased maximum aortic wall and aortic wall thickness, were defined as the regression group. In the maximum aortic diameter, an optimal cutoff value of 40 mm resulted in positive predictive and negative predictive values of 86.7% and 90.0%, respectively. Both a maximum aortic diameter of 40 mm or more (P =.0011) and a maximum aortic wall thickness of 10 mm or more (P =.0009) were shown to be significantly predictive of the progression with Cox regression analysis. CONCLUSION: Maximum aortic diameter and maximum aortic wall thickness on initial CT images are predictive for progression of the affected aorta in patients with type B IMH. For type B IMH with a maximum aortic diameter of 40 mm or more or a maximum aortic wall thickness of 10 mm or more, careful follow-up studies must be required.
Aged↗
New development of an ulcerlike projection in aortic intramural hematoma: CT evaluation.
PURPOSE: To investigate the natural history and predictors of progression of a newly developed ulcerlike projection in patients with an aortic intramural hematoma. MATERIALS AND METHODS: Serial computed tomographic (CT) findings in 52 patients with intramural hematoma were reviewed. Sixteen patients had Stanford type A intramural hematoma, and 36 had Stanford type B. Diagnosis of intramural hematoma was established with CT. Regular follow-up studies were performed every week during the 1st month and two or three times a year after the 2nd month. The presence or absence of an ulcerlike projection, diameter and progression of the projection, and aortic diameter were evaluated. Relationships among ulcerlike projections, clinical data, and CT findings were analyzed. RESULTS: In 17 (33%) of the 52 patients, 17 ulcerlike projections were newly identified during the follow-up period. Patients with type A intramural hematoma had a significantly higher frequency of new development of ulcerlike projection than that of patients with type B intramural hematoma (P =.002). In 17 patients with new development of ulcerlike projection, 12 (70%) of 17 projections progressed to complications such as enlargement (n = 10) or progression to overt aortic dissection (n = 2). One of 10 enlarged projections progressed to rupture. A significant predictor of progression of ulcerlike projection was based on location from the ascending aorta to the aortic arch with the use of univariate (P =.009) and multivariate Cox (P =.018) regression analyses. CONCLUSION: The location of ulcerlike projections is the principal predictor of progression, and careful follow-up study is needed for patients with an ulcerlike projection located from the ascending aorta to the aortic arch.
Adult↗
Esophageal and bronchial perforations after thoracic aortic aneurysm replacement: successful repair with covered metallic stents.
Esophageal and bronchial perforations are rare but potentially fatal complications of descending thoracic aortic aneurysm replacement. This report presents a 67-year-old man with both esophageal and bronchial perforations that occurred after descending thoracic aortic aneurysm replacement. Surgical repair was performed, but the lesions perforated again. Two covered metallic stent prostheses introduced into both the esophagus and left main bronchus led to the improvement of mediastinitis by sealing the perforations. To our knowledge, this is the first report describing successful treatment for esophageal and bronchial perforations using covered metallic stents. Placement of covered metallic stents can be an option for the treatment of patients with esophagorespiratory tract perforations, especially those who are in critical condition.
Aged↗
Cardiac amyloidosis: typical imaging findings and diffuse myocardial damage demonstrated by delayed contrast-enhanced MRI.
Amyloidosis is a rare systemic disease. However, involvement of the heart is a common finding and is the most frequent cause of death in amyloidosis. We report the sonographic, scintigraphic, and MRI features of a pathologically proven case of cardiac amyloidosis. Delayed contrast-enhanced MR images, using an inversion recovery prepped gradient-echo sequence, revealed diffuse enhancement in the wall of both left and right ventricles. This enhancement suggested expansion of the extracellular space of the myocardium caused by diffuse myocardial necrosis secondary to deposition of amyloid.
Aged↗
CT findings of ruptured intramural hematoma of the aorta extending along the pulmonary artery.
Mediastinal hematoma extending along the pulmonary artery is a rare complication of Stanford type A classic (double-barreled) aortic dissection. Rupture from the posterior aspect of the aortic root penetrates the shared adventitia of the aorta and pulmonary artery. From this location, hematoma can spread along the adventitial planes of the pulmonary arteries out into the lungs. We report a case of ruptured intramural hematoma of the aorta (IMH) extending along the pulmonary artery. To our knowledge, this finding in patients with IMH has not been reported in the literature.
Aged, 80 and over↗